The Lord Chancellor: Leave of Absence

Lord Falconer of Thoroton: My Lords, before business begins, may I take the opportunity to inform the House that I will be undertaking a ministerial visit to Sheffield on Friday 3 March? Accordingly, I trust that the House will grant me leave of absence.

Office of the Deputy Prime Minister

Lord Peyton of Yeovil: asked Her Majesty's Government:
	What plans they have for reconsidering and changing the role of the Office of the Deputy Prime Minister.

Lord Rooker: My Lords, any machinery of government changes would be announced in the normal way in accordance with the requirements of the Ministerial Code.

Lord Peyton of Yeovil: My Lords, that was very interesting. I sometimes wonder whether the right honourable gentleman the Deputy Prime Minister actually listens. For instance, does he listen to people who advise against building houses where there is a shortage of water or where there is a danger of floods? Does he listen to those who object strongly to having their police forces bulldozed into one force without their agreement? Can the Minister dislodge from my mind the burgeoning suspicion that if the right honourable gentleman were compared to the proverbial bull in a china shop he would make the latter look quite coy, well behaved and discreet?

Lord Rooker: My Lords, I thank the noble Lord for that question. The Deputy Prime Minister is the first Minister in this country to initiate a policy to make sure that we build on brownfield land and do not waste land. He inherited a building programme where some 56 per cent of dwellings were on brownfield land and has got the amount up to 70 per cent. He eliminated children in bed and breakfast accommodation with a specific plan driven by the department. He has put 3,000 wardens on the streets of this country, which is one of the most popular and cheapest things that the Government have done. I have a list of other issues that I can cite in respect of ODPM. I do not think that the Deputy Prime Minister has a thing to apologise for.

Lord McNally: My Lords, I have no doubt that the Minister's brief is very thorough. However, the Deputy Prime Minister has form. Does the Minister recall that he completely botched his transport policy, made a total mess of devolution and created considerable panic in the south-east with his plans for housing? In those circumstances, can the Minister give us a categorical assurance that the reports in today's newspaper that the Deputy Prime Minister will take overall responsibility for planning the 2012 Olympics are totally untrue?

Lord Rooker: My Lords, the legislation just referred to by the noble Lord was agreed by his party. The implications of part of his question and of part of the question of the noble Lord, Lord Peyton, are no homes for people in the south-east, families driven away and no policy in this area whatever. They cannot have it that way. The Question was about machinery of government issues, not about the policies of the department.

Lord Forsyth of Drumlean: My Lords, now that we have two Prime Ministers, should we not have two Deputy Prime Ministers, given the Minister's enthusiasm for the present one?

Lord Rooker: My Lords, that is an exclusively machinery of government matter for the Prime Minister.

Baroness Hanham: My Lords, if I understand what the Minister has said, the machinery of government is not moving in the direction that my noble friend Lord Peyton was asking about. If there is to be no change of place or role for the ODPM, will the Minister at least give an assurance that it will start to conform with normal consultative processes, particularly over the Miliband review, which seems to have been taking place on an extremely ad hoc basis?

Lord Rooker: My Lords, I would be happy to arrange for my noble friend the Minister from the ODPM to answer policy questions on details of the Miliband review. This Government consult every minute of the day, which is exactly what the ODPM does. There is nothing to apologise for. People may not like what they are being consulted about, but one cannot argue that the ODPM does not consult. Although the title of the department has always been a problem, more people now recognise the work of the ODPM; it is the ministry of housing, of local government, of planning, and of social exclusion, among other things. So I do not think that there is any issue that people can raise which they can complain that they have not been consulted about.

Baroness Gardner of Parkes: My Lords, is the Minister aware that the ODPM has pretty well single-handedly destroyed the hedge legislation by setting out principles for councils to follow that make it intolerable and that those who were so delighted that that legislation had been passed have now found that they can get no joy at all out of it? I am sure that the Minister will be disappointed, because I know that this issue was important to him. It all hinges on the word "removal"—I shall ask another question about this later. People have found some obscure legal case that says that, if a hedge dies, it might be considered to be removed, but that is totally against the principle of the debates that we had.

Lord Rooker: My Lords, I am grateful to the noble Baroness. As she says, we were very sympathetic to that legislation and wanted to get it on the statute book. As she knows, we did not bend the rules but made use of "where there is a will, there is a way" to get it on the statute book. Putting the legislation into operation, being practical and following the guidance can solve most high-hedge problems. I am not saying that it will solve them all or that it has had no teething troubles—I accept that it has—but, as she has said, she will have a detailed Question on the Order Paper in the near future, and she will get a proper, full and positive answer to it.

Lord Sheldon: My Lords, given the need for strong local arrangements, will the Minister say what is happening about the local strategic partnerships?

Lord Rooker: My Lords, the local strategic partnerships are being turned into local area agreements so that there is more joined-up working in local government and the public sector. People might question that, but people used to work in silos. Now, local government is forming partnerships with the private sector, the voluntary sector, job centres, the police and others, who are all involved in community planning decisions. The system is far better now than it was 10 years ago.

Lady Saltoun of Abernethy: My Lords, the Minister said that the Deputy Prime Minister had eliminated children in bed-and-breakfast accommodation. Will he say by what means he did this?

Lord Rooker: My Lords, we did it through a specific programme and a pledge, which I think took about two years from when it was first made, to work systematically with local authorities and housing providers around the country to manage the exercise so that children got into accommodation that had a front and a back door and in general a garden, rather than into bed-and-breakfast accommodation. That commitment was made, delivered on and highly managed within that timescale by the homelessness unit of the Office of the Deputy Prime Minister. So it was not simply a question of someone making a speech and it happening; it was actively managed in the department and driven through by officials, guided by the Ministers.

The Earl of Listowel: My Lords, I acknowledge that taking children out of bed-and-breakfast is a significant achievement, but will the Minister, whose role involves working for homeless families, say what progress has been made in reducing the high of 100,000 families living in temporary accommodation?

Lord Rooker: My Lords, I accept what the noble Earl says, but I must also say, as has been said before, that in reality temporary accommodation is not quite as people might imagine it to be. Accommodation that is classed as temporary sometimes becomes people's permanent home. We are talking about houses and flats with their own doors, and families can be placed in accommodation that is classed as temporary while they have a particular problem. It can sometimes, although not always, become their permanent accommodation. It is not temporary in the sense that it is transient and bed-and-breakfast. We are talking about proper homes here.

Israel and Palestine: Road Map

Lord Blaker: asked Her Majesty's Government:
	What is the present status of the Israeli-Palestinian road map.

Baroness Royall of Blaisdon: My Lords, neither side has met its full phase 1 commitments. We, along with our EU partners, will continue to work with the Palestinians, the Israelis and the international community to make progress on the road map, to which both the Palestinian President Mahmoud Abbas and the Israeli Government remain committed.

Lord Blaker: My Lords, I welcome that statement, although it will be difficult to make progress with the road map in the present circumstances. Is the noble Baroness aware that in the recent Palestinian elections the turnout was 77 per cent, which puts us a bit in the shade, and that the European Union monitors gave those elections a good report? Is she aware that the European Union's policy to give finances to the Palestinian Authority and consequently to Hamas is much more sensible than that of the United States and of Israel, which are reducing cash flows to the Palestinian Authority? That sort of action could result in Hamas being driven into the hands of Iran, which has recently offered financial support. Should we not be seeing whether the responsibility of government in the hands of Hamas leads it to adopt a more moderate policy than it has pursued most of the time in the past, although it is worth remembering that Hamas has for the past year had a ceasefire and that that was supported by the newly appointed Prime Minister-designate of Hamas?

Baroness Royall of Blaisdon: My Lords, the noble Lord is absolutely right: the elections were free and fair, and we recognise Hamas's democratic mandate. However, those who enter a government cannot expect to be treated by the international community in the normal way until they forswear violence. That having been said, this Government fully support the European Union in the way that it is continuing its funding to the interim authority in the Palestinian state. We will maintain our support until we see what happens with a government in that area. We have a month yet in which to see that pressure is exerted, to some extent, on Hamas to ensure that it follows a democratic and peaceful way forward.

Lord Clinton-Davis: My Lords, would it not be a good first step for Hamas to renounce its oft-repeated claims to destroy Israel? Does not my noble friend agree that, until that happens, it is difficult for anybody to recognise the claims of Hamas?

Baroness Royall of Blaisdon: Yes, my Lords, the UK Government, the European Union and the quartet are urging Hamas to recognise the state of Israel and to recognise the need for the road map and the agreements that are taking place along the way. I fully agree with my noble friend's position.

Lord Wright of Richmond: My Lords, does the noble Baroness accept that the Prime Minister-designate of the Palestinian Authority, Mr Haniya, has, as the noble Lord, Lord Blaker, said, supported a ceasefire for the past year in spite of the continued expansion of Israeli settlements, the continued construction of the so-called security fence and the targeted assassinations against supposed militants in Gaza?

Baroness Royall of Blaisdon: Yes, my Lords, we recognise that that is the position taken by the acting Prime Minister, and we celebrate that to some extent. However, Hamas as an organisation still must recognise its international obligations; it must recognise the state of Israel. That said, the Government continue to express their deep concern about settlement activity and about the barrier.

Lord Howell of Guildford: My Lords, the noble Baroness spoke a few minutes ago about having a few weeks to wait until Hamas took up office, and she is right about that. Is it not really much the best thing for all parties to prevent the immediate collapse of the Palestinian Authority, which would do no good to anybody, least of all to Israel, and to see whether Hamas is prepared to face the realities when it comes to power?
	Is there not a danger that members of the quartet are breaking ranks over the matter, with the Russians virtually recognising the Hamas Government and Turkey giving them a high degree of recognition as well? Is that not of concern to the Government? What happens if there is a Hamas-backed coalition, which there might be, as nine Hamas Members are already in prison and there is no arithmetical majority? How will we deal with that? Can the noble Baroness indicate the Government's thinking on those eventualities?

Baroness Royall of Blaisdon: My Lords, I am grateful to the noble Lord for agreeing that it is important to wait and to take time over these things. In the mean time, as I said, we will continue to support the interim authority and the people of Palestine, as it is particularly important that the people on the ground do not suffer. I would not agree at all that the quartet is breaking up; it is still a strong unit. We know that the Russians have been talking to Hamas. However, that does not call into question the structure and the solidity of the quartet. We believe that the quartet will continue to act on a united basis.

The Lord Bishop of Exeter: My Lords, is the Minister aware of the statement issued recently by the patriarchs and heads of Churches in Jerusalem, in which they have affirmed their commitment and that of their communities to working for a two-state solution that is based on international law and provides a truly viable, contiguous, independent and sovereign state for Palestinians as well as for Israelis? Will she confirm that Her Majesty's Government share that commitment? Will she also comment on the importance that Her Majesty's Government attach to inter-religious dialogue such as that fostered by the Churches through the Alexandria process as part of the search for just such a political solution?

Baroness Royall of Blaisdon: My Lords, the Government warmly welcome the statement made by the patriarchs. We fully support the statement as outlined by the right reverend Prelate. Yes, indeed, we recognise and are grateful for the inter-religious actions taking place in Palestine and Israel.

Lord Steel of Aikwood: My Lords, does the Minister agree that the route of the separation wall remains one of the obstacles to the resumption of the road map? If so, when are the Government—either in the EU or the quartet—going to do something about that transgression of international law, rather than just wringing their hands?

Baroness Royall of Blaisdon: My Lords, neither the Government nor the EU are simply wringing their hands. We are making representations all the time bilaterally through the EU and through the quartet to the Israeli Government to say that the construction of the barrier on Palestinian land is illegal. We will continue to make that case until there is some action on the part of the Israeli Government.

Roads: Congestion

Lord Hamilton of Epsom: asked Her Majesty's Government:
	Whether they plan to review their commitment to reduce road congestion.

Baroness Crawley: My Lords, Her Majesty's Government remain committed to tackling road congestion as outlined in our 2004 White Paper The Future of Transport. Highways Agency traffic officers are patrolling motorways throughout the country to clear incidents and to keep traffic flowing, and local highway authorities have now appointed traffic managers with new duties under the Traffic Management Act. Improvements to road capacity are being made, and trials of innovative new traffic management systems are in progress.

Lord Hamilton of Epsom: My Lords, I thank the noble Baroness for her Answer. I have another question about the Deputy Prime Minister. In 1997, he indicated that he wanted to move travellers from the roads on to the railways. Since then, there has been a massive expansion of passenger traffic on the railways. There are now serious constraints on expanding many lines on the railways. Over the past seven years, congestion on the roads has grown worse by 11 per cent. Was it not a great mistake for the Deputy Prime Minister in 1997 to abandon so many of the road programmes that he had inherited from the Conservative government? Has that not led to the problems that we have now?

Baroness Crawley: No, my Lords, I do not agree at all with the premise of the question of the noble Lord, Lord Hamilton. We have a robust set of initiatives to tackle congestion on roads. We have also put unprecedented investment into rail. Therefore I do not take that point. We are tackling congestion on roads, which arises, as the noble Lord knows, partly because of economic success. More people travel longer distances and more goods are transported across longer distances, as the noble Lord knows from his own experience. The initiatives that we are taking to tackle congestion are many and varied. I could go on at great length about the list that I have.

Lord Marsh: My Lords, congestion, particularly of cars, is a massive problem in most large cities in the world, but the $64,000 question is why no city in the world has ever come to a standstill. That is because motorists on all roads eventually—in two, three, four, five or six years—retreat to an acceptable level of congestion.

Baroness Crawley: My Lords, that seems a bit of a recipe for doing nothing—a wait-and-see policy perhaps. The noble Lord will know that the challenge is to keep the traffic flowing. Therefore, we must accept that congestion is on the increase, as the noble Lord, Lord Hamilton, said, and that it will continue to increase. The challenge is how we manage that increase. How do we ensure that people have, for instance, good information so that they know the best times to travel to avoid the difficult peak periods? How do we get our targets right for our motorways and large trunk roads, as well as for our local roads?

Lord Tomlinson: My Lords, will my noble friend reflect on the fact that she was far too kind to the noble Lord, Lord Hamilton? He recognised that there had been an increase in rail traffic. Perhaps she should add that that is despite the botched privatisation, the fragmentation of the railway industry and the state of near-bankruptcy in which the previous government left it.

Baroness Crawley: My Lords, my noble friend pre-empts my response to the fourth Question.

Lord Stewartby: My Lords, will the Minister commit the Government to taking a valuable step towards dealing with some of the congestion problems in London by banning bendy buses, which create nothing but congestion at corners and roundabouts in particular?

Baroness Crawley: My Lords, bendy buses have their fans as well as their detractors. Congestion in London has decreased in recent times.

Earl Attlee: My Lords, what is the Minister doing to promote and encourage proper, informed debate about the possibility of general road user charging rather than lots of discrete systems in different cities?

Baroness Crawley: My Lords, the noble Earl, Lord Attlee, will know that the road pricing policy that was in our manifesto is being examined. No decisions have yet been made nationally because a lot more development work needs to be done. Perhaps more important, people are understandably concerned that a radical change might be detrimental to them. Therefore, we recognise the need to make the case for road pricing to the wider public, which we will continue to do. Certainly, there is a lot of discussion around that issue, which may well be one of the solutions to the congestion problem.

Lord Vinson: My Lords, if the railways have successfully been brought up to full capacity, is it not time that we tried to finish our motorway system? What other country in the world has its major trunk road—the equivalent of our A1—not even dual-carriagewayed, without flyovers and with hugely bottleneck-making roundabouts? Is it not time that we got on with a proper motorway/A1 system from north to south and south to north?

Baroness Crawley: My Lords, I agree that, where the case is made, it is important to get on with providing new capacity and investment in our roads system. For instance, £1.3 billion is being invested in new road capacity and improvements to existing roads over the period 2005 to 2008. However, we cannot tell ourselves that we can simply build our way out of the congestion problem. Environmentally, economically and socially, that is not possible. However, where there is a good case for new capacity, we are getting on with it.

Crime: Violence on Trains

Baroness O'Cathain: asked Her Majesty's Government:
	How they plan to tackle the rise in violence on trains.

Baroness Crawley: My Lords, the Government continue to support the work of the police, local authorities and transport operators to tackle crime on public transport. We are developing good practice on reducing crime and the fear of crime wherever it occurs in the transport system. Through the implementation of legislation and increased funding, the British Transport Police is fulfilling its responsibilities for policing the railways.

Baroness O'Cathain: My Lords, I thank the Minister for that reply. However, I was talking not about crime but about a part of crime: violent assaults. In 1999-2000, there were 4,428 violent assaults on passengers on the rail system in England and Wales. In 2004-05, that had increased to 6,354—a 43 per cent increase in violent assaults. I remind the noble Baroness that in 2000 the Government said in the 10-year transport plan:
	"We want people to travel safely and to feel secure".
	A 43 per cent increase in violent assaults means that that goal has not been achieved. In answer to the previous Question, she said that there was "unprecedented investment in rail". There was obviously none in security—or, if so, it has been misspent.

Baroness Crawley: My Lords, any increase in violent crime is a matter of grave concern to the Government. We are doing a great deal to put in place systems to ensure a reduction in that increase. For instance, we are looking at the ways in which stations can be made more secure. We are considering facilities in those stations, and we are talking to the train operators about getting more CCTV and better lighting into stations. When some of the stations were built, many years ago, the safety of the person was not necessarily uppermost in people's minds, whereas now it is.
	The noble Baroness talked about the rather dramatic increase in violent crime. She will know that one of the reasons for the increase in that category was that from April 2002 all police forces in England and Wales were required to record all violent offences, however minor, despite the victim having no desire to report the incident, provide evidence or assist the police in any way. So, yes, there has been an increase. There was a difference in the way that the figures were recorded. However, we are not complacent. On trains and in stations we want to meet that issue head-on and try to reduce the figures.

Lord Bradshaw: My Lords, will the Minister reflect on the fact that, in December last year, the House of Commons Public Accounts Committee reported that few train operating companies had joined national schemes to reduce crime and increase personal safety? Does she agree that the way in which franchises are now being let gives little incentive to train operating companies to join secure station schemes? Only 10 per cent of stations are secure. That is because the Department for Transport insists on the lowest possible price, which causes every potential franchisee to cut every scheme to the bone.

Baroness Crawley: My Lords, I do not agree with the noble Lord. We would encourage TOCs to join the secure station scheme, which I am sure is the scheme that he addressed. We want to involve more than the 300-odd stations that are in the scheme.
	In the new franchises—for instance, the Kent franchise and those for Thameslink, Great Northern and Great Western—the potential franchisee is now required to submit a security plan in the bid. They get nowhere near a bid until they submit a security plan dealing with a number of issues, such as the security of the customer and of stations. Those are then captured in the final franchise agreement. I would not say that we are not encouraging them.

Lord Berkeley: My Lords, does my noble friend agree that one way in which to improve security in trains is to have trained staff patrolling in the train? Is she aware that every train that goes into and out of Waterloo has a guard sitting in a compartment who never sees anybody at all? When the department lets the new franchise for South West trains, could that be changed so that the guards become patrolling ticket collectors and provide a level of security to passengers on the many trains that go in and out every day?

Baroness Crawley: My Lords, I very much agree with the thrust of my noble friend's question—when there are staff, they should be visible and give confidence to the travelling public. He will know that there is a railway staff accreditation scheme that allows the chief constable of the British Transport Police to confer limited police powers on specific employees. Accredited people who have those powers do a valuable job in reassuring the public and contributing to the fight against crime. The South West security plan is still to be established, as my noble friend will know, so there are no plans available for that specific franchisee at the moment.

Government of Wales Bill

Brought from the Commons; read a first time, and ordered to be printed.

London Olympic Games and Paralympic Games Bill

Lord Grocott: My Lords, I beg to move the Motion standing in the name of my noble friend.
	Moved, That the amendments for the Report stage be marshalled and considered in the following order: Clauses 1 to 3, Schedule 1, Clauses 4 to 8, Schedule 2, Clauses 9 to 32, Schedule 3, Clause 33, Schedule 4, Clauses 34 to 42.—(Lord Grocott.)

On Question, Motion agreed to.

NHS Redress Bill [HL]

Read a third time; an amendment (privilege) made.

Lord Warner: My Lords, I beg to move that this Bill do now pass. I thank noble Lords who have taken part in our debates in the past few months, particularly the noble Earl, Lord Howe, and the noble Baronesses, Lady Morris of Bolton, Lady Barker, Lady Neuberger and Lady Tonge. I thank also my noble friend Lady Royall of Blaisdon. I am grateful to all noble Lords for the constructive spirit in which they debated the Bill. I am, of course, a little disappointed that by the narrowest of margins the Bill leaves the House with a single but somewhat expensive blemish, but I do not doubt that the prospects of that being remedied are good. On behalf of all noble Lords I thank all the officials from the Department of Health, the Wales Office and the Assembly, who have done a good job on this Bill. Our grateful thanks to all of them.
	Moved, That the Bill do now pass.—(Lord Warner.)
	On Question, Bill passed, and sent to the Commons.

Council Tax (New Valuation Lists for England) Bill

Report received.
	Clause 1 [Dates on which new valuation lists must be compiled for England]:

Baroness Hanham: moved Amendment No. 1:
	Page 1, line 5, leave out subsection (2).

Baroness Hanham: My Lords, noble Lords who were present in Committee will know what the amendment does. It would prevent any future order for revaluation in England, and it is an exact replica of our amendments from Committee.
	I listened to the Minister's arguments in Committee with great interest, as I always do, and, unsurprisingly, they covered much of the ground that I expected them to cover. Her Majesty's Government believe it is unlikely that there will be a revaluation within this Parliament, and the Michael Lyons report was used as a reason for postponing revaluation. The Minister did not satisfy me in her answer on why it was necessary to provide the Secretary of State with such unfettered powers in this Bill over revaluation, when it comes. She said:
	"This is very much a postponement, not a cancellation".—[Official Report, 7/2/06; col. GC297.]
	In reality it is a cancellation, albeit a temporary one—although we do not know how temporary. It is a cancellation because no provisions are being made for future revaluation plans and there are no comprehensive plans for local government finance.
	The Minister said it was important to ensure that revaluation was stopped at the point at which we would not only be saving money, but would also be introducing clarity and certainty in the process. I am completely at a loss to know how this Bill provides any clarity or insight. The plans seem even less clear when we are presented with a Bill that allows the Secretary of State to call a revaluation when he or she chooses, regardless of changes to council tax banding or the timescale of that revaluation. Nothing in the Bill says that the Secretary of State must give a certain amount of notice for revaluation. What is to stop a revaluation being ordered in January for completion by April? I do not suggest any Secretary of State would be so rash as to do it in that time; I merely wish to point out that it would be possible, because of the uncertainty and lack of clarity that accompany the rather vague provisions in the Bill.
	I drew attention earlier today to the Miliband review. I do so again now, as I will in Committee, because it is an example of something that pops up out of the woodwork and is then carried forward. It is not legislation at the moment, while the Bill is, but the Government have a propensity for things happening at quite short notice.
	When we last met to debate this Bill, the Minister talked about how soon we could expect a revaluation after Sir Michael Lyons's report was made available to us. It was clear that she did not know. The clearest thing that came out of our previous debate is that the Government are not really sure about the future arrangements for council tax, banding or the timing of revaluation.
	I do not see why this Bill should make such wide provisions to enable the Secretary of State to call for revaluation at whim. That is the reason for our amendment. It is not to seek to blow revaluation out of the water, but rather to ensure that, when it does come back, it does so in a way that is structured and relevant to parliamentary processes. I beg to move.

Baroness Andrews: My Lords, I am grateful for the noble Baroness's clear reiteration of her position. She has raised a number of interesting points here and in Committee. Her final words were that she had no intention of blowing revaluation out of the water, but as I pointed out in Committee, this amendment would cancel revaluation altogether. That position is not only more definitive than that taken by her colleagues in the other place, but it means there can be no future revaluations ever. I know noble Lords opposite have shown a commitment to council tax, and are concerned about its credibility. The noble Lord, Lord Hanningfield, has made that very clear in Committee. I would have thought that their position as they have presented it is very problematic now.
	I want to allay the noble Baroness's concerns. She is concerned that it is an unfettered power. Let me first deal with the fact that it is not an entirely new power for the Secretary of State to set the date of and the timing between revaluations. As a veteran of the 2003 Act the noble Baroness will know that under existing provisions the Secretary of State already has the power to set the date of revaluations; he can do so at any point within the 10-year cycle. The only restriction on the timing of the use of the power is that if it is going to be used it must be used before the 10th anniversary of the previous revaluation. In other words, he already has complete flexibility to set the date of revaluations at any time, provided it is before the 10th anniversary.
	The Bill seeks simply to remove the 10-year maximum time frame between revaluations, and leave the Secretary of State with the power to determine when any future revaluation might happen. It is simply a variation on the previous power; it provides more flexibility.
	The noble Baroness also asked why we now seek to change the existing arrangement for the timing of revaluation. This was raised in Committee when the noble Lord, Lord Hanningfield, argued that we should simply bring forward a Bill that stopped the intended revaluation in its tracks and provided no power to set a new date. That is what the amendment did. He also suggests that we should wait until we receive Sir Michael's final report before making any changes. If we had taken the first route, and simply cancelled revaluation—and it is not a cancellation—without providing a power to set any future date we would have, in effect, cancelled revaluation for all time. We have made clear at every stage of this Bill that we have no intention of doing that. We are committed to postponing but not cancelling revaluation because we believe it is right to maintain a fair alignment between house prices and council tax bands. That is where the certainty lies.
	The noble Baroness pressed me on clarity. The whole point about postponing the council tax revaluation until we have the full findings and recommendations of the Lyons report—which is looking at form and function in local government in the context of a lot of changes as well as council tax funding—is precisely because we want to introduce more clarity into our deliberations on council tax revaluation when we take them. We will have the benefit, not only of his judgment but of the collective judgment of everyone who has taken part in that process. It is a generous and open consultation and from the interim report itself one can see how seriously and how widely Sir Michael is engaging with the process.
	We announced to the House at the earliest opportunity, in the light of that decision and the need to keep costs to a minimum, that preparatory work was stood down with immediate effect. I am sure that the noble Baroness would have been the first to challenge me about why we were letting the VOA run on with its work if revaluation had stopped. We had to act immediately to remove the statutory deadline. That in itself is clear and certain, too, because if we had not done that the VOA would have been in an impossible situation of remaining under the statutory obligation to revalue.
	Let me add one further point about clarity and certainty. Even if the Government had concluded—we have not—that revaluation was likely to take place in this Parliament, the revised timetable for Sir Michael's inquiry at the end of this year and the need to take full account of his work would have left insufficient time for us to consult on his recommendations and then come forward with a properly developed package of reforms and a date for revaluation. I therefore ask the noble Baroness to consider whether that is not a commitment to the greatest clarity in a process that we have laid down as clearly as possible.
	It was asked why we did not wait for Lyons. We thought it sensible that, while we were putting through this necessary legislation which I know the opposition support, we should also take the opportunity to remove the 10-year maximum timetable for revaluations. In doing that, we would provide Sir Michael Lyons with a clear field for his inquiry to come forward with such recommendations as he thinks appropriate and with no pre-existing constraints. That is an important definition of independence. However, in order to ensure that revaluation can happen at some point, we must give the Secretary of State a power so that we have the necessary mechanism in place for setting the date for revaluation. Nothing would have been gained by waiting for his report before we took legislative action.
	The noble Baroness expressed concern about the Secretary of State's unfettered powers. I am sure that we will return to the subject on other amendments, but I reiterate that this order-making power, which was passed by both Houses in 2003, is subject to the power of affirmative procedure in the other place. It is open to full scrutiny, debate and Division. It is not an unfettered power. This amendment would return us to a situation that denied us any chance in the future to update a council tax system that would be based on increasingly out-of-date valuations and with no mechanism through which to address that without further recourse to primary legislation. That is not a sensible way forward and I do not believe that noble Lords opposite believe it is either. We need a system that allows the Government to proceed in due course in clarity, in the full light of Sir Michael's work and in the light of our recognition that the maintenance of a fair alignment between house prices and council tax is linked to wider questions about the structure of council tax and the operation of council tax benefit.
	I therefore hope that the noble Baroness will accept my reasons and reassurances and withdraw the amendment.

Lord Hanningfield: My Lords, before the noble Baroness sits down, I notice that she mentioned my name two or three times. The point we were trying to make is that while we wholeheartedly agree with the Government that legislation is necessary—you have cancelled the revaluation and there has to be legislation to endorse that—all other things should be left until after the Lyons review. We made the point clearly in Committee that a revaluation may never be needed in its current form. I believe that it is politically unsustainable anyway. Any government would have a very great job in having a full-scale revaluation. There are other ways of doing it. The noble Baroness did not mention those issues at all. Why do the Government feel compelled at this stage to put in other things before the Lyons review rather than just cancelling the current revaluation and then waiting for the Lyons review, which we hope will give us answers we like? Perhaps the noble Baroness can clarify the position.

Baroness Andrews: My Lords, I am sorry if I have not clarified it; I thought that I had. As I said, we believe that it is very important to provide a power that allows the Secretary of State to bring a further date forward in due course. It is not a cancellation; it is a postponement and that would be made clear. We also believed that it was important to remove the 10-year time frame because it would give us an opportunity to open the field for Sir Michael Lyons to be as free and radical as he wishes. At the same time, we have taken the opportunity to say that there is no point in waiting for Sir Michael Lyons, but that it is important to provide this power so that we do not have to come back to the House with primary legislation. I should think that that would commend itself to the noble Lord for all sorts of reasons. I am sure we will be able to debate some of the other issues he raised in debates on other amendments.

Baroness Hanham: My Lords, I thank the noble Baroness for that reply. The reason for the revaluation postponement or delay is Sir Michael Lyons's report; we have recognised from the outset that that is the rationale for the postponement. Now there is also the other intervention of the Miliband review. There is now a very wide review of not only local government structures but local government procedures, council tax and finance. It seems to us that, with all of that, if the Government are to accept any of Sir Michael Lyons's recommendations—and bearing in mind that Mr Miliband is running around doing behind-the-scenes consultation on the structures which are not subject to a formal consultation paper, as I was trying to point out at Question Time—it will be extremely difficult for them to avoid having to come back with primary legislation.
	I hear what the noble Baroness says. I think that we will have to disagree about what should happen on revaluation. Our view, as I hope I have made clear, is that with Sir Michael Lyons's intervention and now with the Miliband review, this thing ought to fade away. There should be, not a postponement, but an end to revaluation. If the Government wish to revalue at some stage because the council tax is in the same form then they should come back with primary legislation. Meanwhile, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Hanham: moved Amendment No. 2:
	Page 1, line 7, leave out from "England," to end of line 8 and insert "on a date prior to the making of any order under section 5(4) and (4A) of that Act.""

Baroness Hanham: My Lords, I return to an amendment that I moved in Committee. I noted that the noble Baroness, Lady Andrews, said that she thought that that amendment was "tautologous". That is a wonderful word, so I thank the noble Baroness for giving me the opportunity to use it again; it trips off the tongue. I went away to read her comments. Having done so, I am returning to this matter, because the crux of her argument came down to one revealing sentence, which I shall quote. She said that,
	"any revaluation could use only the existing banding structure, because there could be no change to bands until after a new valuation list had been compiled . . . Bills would be issued against this list because they would be bound to be, and only then would it be possible to make the necessary changes to band structure to account for inflation and any other reforms thought desirable".—[Official Report, 07/2/06; col. GC306.]
	There is an issue here. The whole point of the amendment was to ensure that the council bands could not be changed between now and a revaluation, or unless a revaluation was proposed.
	I suspect that this is not as much of a chicken and egg situation—I think that the words were "horse and cart"—as the Minister has suggested. Her words suggest that any other reforms that were thought desirable could be made after a revaluation had been completed. In bringing back this amendment, I believe that it would be short-sighted in the extreme to plan to have reforms as an afterthought to revaluation.
	It is hardly the fault of our Benches that the Bill allows for so little scope. If the Bill more comprehensively provided for the needs of council tax—which I know is not, and was never, its purpose, although it should have been—these issues would have been addressed; they are all interdependent.
	The amendment would ensure that the revaluation occurred before bands are changed. No decision can be made on council tax bands until a view of the full council tax valuation spectrum is available—if, indeed, it is required and necessary. From the Minister's explanation, the only thing that would work would be that council tax bills would be issued after a new valuation, although under the old banding scheme, which would mean that the people whose houses had risen up the bands would be hard hit. Can the Minister say what would prevent the Government from changing legislation so that Bills would be issued only after the new banding system was in place?
	The Minister described the complicated set of events that led to the final revaluation list. The amendment, far from confusing that process, is intended to bring order to it, starting with the basic value and proceeding to the banding and then to the issuing of bills. Widening council tax bands disproportionately hits areas with high property values, which are not necessarily the same as areas of high income.
	We have seen council tax rising at twice the level of inflation per year—over 76 per cent since 1997. It is about time that the Government properly reassessed their local government finance strategy, which could take account of a revaluation if it became necessary. I beg to move.

Baroness Andrews: My Lords, there is a touch of déjà vu in our debate on this amendment. Reluctantly, I must reiterate some of what I said in Committee, because the effect of the amendment is the same. But I shall address the principle that the noble Baroness stated—the link between reform and revaluation.
	Essentially, the amendment would prevent any changes from being made to council tax bands—the proportion, the values and the number of bands—without first compiling new valuation lists through a revaluation exercise. The aim is, as the noble Baroness has made clear, to make sure that such changes will always be linked to, and indeed follow, a revaluation. I hope to be able to explain how we are indeed sympathetic to that principle. The effect of the amendment is, however, exactly the same as before. Before I address the issues of principle, I shall say in a condensed form why the amendment cannot work.
	I have already said that the amendment would require new valuations to be compiled before any changes could be made to the band structure. Dwellings would have to be valued and then allocated to one of the existing 1991 bands. The obvious implication is that, given house price inflation, the vast majority of properties would automatically shift up at least one band. Furthermore, with so many properties clustering in the top few bands, the ability to differentiate between relative rates of council tax for different properties would be lost. One could not, therefore, compile new valuation lists without at least adjusting the value range of each band and without there being serious unintentional consequences on a large number of council tax payers. The noble Baroness has accepted this point, so I will not dwell on it, but these are the impacts which go beyond what is just and rational.
	I will concentrate on the noble Baroness's underlying concern—the notion that we would spring changes to the band structure of council tax in isolation from a revaluation and without due consideration. The noble Baroness used the term "afterthought". The suggestion is that these changes would be a decision on the spur of the moment. The history of council tax seems interminable, but it is actually quite short. This is the first approach to revaluation. The Government decided to postpone it precisely because they did not wish to make any of these changes before a proper consideration of and consultation on all the issues. We will have that, thanks to Sir Michael Lyons's final report and recommendations. I hope that the noble Baroness will see this as helping to meet the concerns of her amendment.
	The expectation when Sir Michael started his work in July 2004 was that his recommendations for the reform of council tax would be fed into the 2007 revaluation. Far from being an afterthought, the link was there and it is there now in our proposal. It is a clear indication that the Government—and any sensible future government—would recognise that revaluation and reform normally go together as one complete, logical package, and not as two separate or separable elements. That is not to say that, under current provisions, reforms could not be brought forward without revaluation. But that would be extremely unlikely, particularly given the detail involved.
	For clarity, let me reiterate. The Local Government Act 1992 provides for the Secretary of State to make changes to the number of bands, the value range of each band and the ratio between bands. I hope that this provides further reassurance that reform and revaluation are linked. The first two potential changes to the banding system could not happen in any sensible form in isolation from revaluation. If we added another band at the bottom, say, how could we fairly allocate properties to that new band without first carrying out a revaluation, even if that revaluation were to 1991 values? If we changed the value range of each band, how would we know what new values to adopt without again going through a revaluation? The only remotely possible change the Secretary of State could order in isolation from revaluation might be a change in the ratios between bands. But to do so in isolation from revaluation seems to me to be extremely unlikely. Any such fundamental change would surely require the Secretary of State to reassure himself—and everybody else—that the bandings of individual properties provided a reliable basis for the reform. It is in that way that credibility lies.
	Finally—I address this point particularly to the noble Lord, Lord Hanningfield—the noble Baroness's own party has indicated in both Houses that it welcomes the use of the flexibility provided by the existing arrangements to adjust the system without the need for revaluation. We discussed the matter in Committee and I know that the noble Lord has given evidence to the Lyons committee, but I am not entirely sure what he or, indeed, other people might have in mind as to the way to proceed. We do not have the details. But it is clear that flexibility would be required in these matters. That flexibility is taken away by the amendment. This amendment, combined with the others proposed this afternoon, seems to me to threaten to paralyse the entire system, and I cannot believe that that is what the party opposite would want.
	The noble Baroness asked me whether we could revalue but postpone the issuing of bills until after the bands had been changed. Technically, that might be feasible if the necessary legislation were passed, but it would be impossible in practice. Where, I might ask, might local government get its money? Disjunction in the system follows from that.
	I hope that I have been able to provide reassurance that changes will always be linked: in practice, the structure and the revaluation will always be linked. I hope that that is reassuring for the noble Baroness and that she will be able to withdraw her amendment. I hope that she will also be reassured that there are absolutely no plans to make any changes to the council tax system until we have considered Sir Michael's report and recommendations.

Lord Hanningfield: My Lords, before the noble Baroness sits down, perhaps I may intervene, because she mentioned something that I said. Basically, we want to freeze the system for the moment. Given that the Government need the legislation to stop the revaluation, we do not want anything to happen with regard to moving bands or anything else until the Lyons review has reported and until there has been a big dialogue about the future. At the moment, for example, pensioner groups are refusing to pay council tax. I advise them to pay the tax; they should not be putting themselves in the position of going to prison. But the system is so unpopular that there has to be a big debate about how it goes forward.
	Basically, the amendments that we are putting forward are to ensure that there is no change in the bands and that nothing happens other than a cancellation of the revaluation until the Lyons review has reported. Then we will expect there to be further legislation, as my noble friend Lady Hanham said a little while ago. Our amendments are attempting to do that. They give the Government the powers that they need but, at the same time, they propose that we wait to see what happens. As I suggested, there are different ways of proceeding which the public might accept. Therefore, let us have a chance to have a dialogue about those things rather than put things in statute that are not necessary at the moment.

Baroness Hanham: My Lords, I thank my noble friend for his intervention—as always, he was straight, succinct and practical. I also thank the Minister. I want to go away and read Hansard carefully. It is awful when one says that after having just listened to what someone has to say, but it seemed to me that the noble Baroness almost accepted our amendment. Although she did not stand up and say that she was accepting it, she implied that it was quite sensible that revaluation should precede any prospect of rebanding, changing the ratios or doing anything to the council tax.

Baroness Andrews: My Lords, perhaps I may put on the record now that I would not find it possible to accept the amendment. I said that it was unworkable and unnecessary.

Baroness Hanham: My Lords, I thank the noble Baroness for that clarification. We may return to this matter but, for today, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Scott of Needham Market: moved Amendment No. 3:
	Page 1, line 8, at end insert—
	"( ) The Secretary of State shall decide at least once in each calendar year whether to exercise the power granted by subsection (1A) and shall give reasons for his decision."

Baroness Scott of Needham Market: The Minister mentioned déjà vu and I am afraid that we are going to continue in that vein because we debated this amendment in Grand Committee. However, at that time, the noble Lord, Lord Bassam, who was replying on behalf of the Government, concentrated his remarks almost entirely on the question of property price divergence. Because of that, I have removed that element from the amendment, as I want to concentrate on the principles. I still contend that over time—let us remember that we are now using a base which is something like 14 years old—divergence of property prices is an important issue, but I have removed that because, as I said, I want to concentrate on the principles.
	The Minister said—I paraphrase—that the Bill does not fundamentally change the powers of the Secretary of State except to remove the obligation to revalue at 10 years. She is saying, "Well, what's all the fuss about?". It is precisely because the revaluation at 10 years has been removed that we see a problem, because the certainty of doing something within that timescale has been replaced by the power of the Secretary of State to revalue at any time in the future. That will be done by order, and only through the House of Commons.
	My amendment would require the Government to consider annually whether a revaluation is justified—moving from the position whereby the Government may order a revaluation to a position whereby they would have to consider it. They would report to Parliament and then on to the wider world on their deliberations. I am happy to concede that the period might be two or three years rather than annually, but I want the principle to be accepted. Putting it into the Bill would give a formal basis for consideration of what is, after all, a major piece of public policy that attracts a great deal of controversy. In the absence of the 10-year stop that was in the previous legislation, we need certainty, which reporting to Parliament would provide.
	The Minister said that this was not cancellation but postponement, which implies that there will be a revaluation. In Grand Committee, the noble Lord, Lord Bassam, said that the factors to be considered in determining the right time for revaluation were many and complex and that sadly we did not have a neat formula to give us the answer. Quite so. It is precisely because at no point in any of our debates have Ministers explained how the determination is to be made that we feel uneasy. Whether we are citizens, involved in local government or parliamentarians, we seem to be being asked to take on trust that such a system in government exists and that it is robust. It may well be, but we do not know that in the complete absence of any mechanism to report to Parliament how the Government are thinking.
	If the Government are confident that they have robust systems, they have nothing to fear from coming to Parliament now and again and being transparent about their thinking on revaluation. If they are not confident but wish to base their position on political expediency, their reluctance would be more understandable. But I find that hard to believe. I beg to move.

Baroness Andrews: My Lords, the party of the noble Baroness is nothing if not consistent. This is not the second but the fourth time that both Houses have debated a version of the amendment, which would require the Secretary of State to consider each year whether to exercise the power provided by subsection (2) to set a date for revaluation and, whatever the outcome of his decision, to give reasons for it. In other words, he would have to produce a report annually—or at some other interval—of his consideration and justification.
	The noble Baroness has argued, as she did in Committee, that the amendment is necessary because it would introduce some certainty, clarity and accountability into the process, whereas at the moment the Secretary of State can allow a situation to drift until, at a whim, he decides to impose, without public debate and in isolation, a revaluation decision. She suggested that her amendment would give the country and Parliament an opportunity to consider and to understand the reasons for revaluation, or no revaluation, on an annual basis, and that this would reassure everyone that the right decision was being taken for the right reasons at the right time.
	Before I deal with the reasoning behind the amendment, which I believe is well meant but unsustainable, let me deal with the practical implications, which are not only unnecessary but counterproductive. This amendment is different from the previous one. The noble Baroness removed the reference to house price divergence. We dealt with that comprehensively in Committee, but, nevertheless, removing the dog does not mean that you have dealt with the bark. There is an issue about what else might credibly prompt revaluation, given the rationale for revaluation and its structure and history.
	The noble Baroness has accepted my argument that there can be no golden rule. Nevertheless, with or without that specific reference to house price divergence, the arguments about levels of divergence would be bound to remain the main focus of the debate. That would inevitably mean that an annual review of this sort would be concerned with divergence of prices. It would occur not only at the point of the year when it was being debated properly, but would fill up the empty months between them, too. As we argued before, that focus would inevitably require us to go through something akin to a full revaluation exercise every year. That seems to me to be a recipe for greater uncertainty and turbulence than anything that we have at the moment.

Baroness Falkner of Margravine: My Lords, as my noble friend has suggested, would the Minister consider a longer period—perhaps a period of three years or five years—before such a report were made? Surely it would be in the interests of transparency, forewarning and stability if the Secretary of State shared his views periodically—as I say, every five years—on where the land lay as regards revaluation. At the moment, as the Government would have it, this is an entirely arbitrary decision.

Baroness Andrews: My Lords, I believe that there are systems and measures built into our present arrangements and the way in which the debate is conducted should allow for trust and certainty. If I may, I shall develop that argument. Previously, I have explained that the Government are concerned about the unhelpful and continuing argument. Frankly, it would not matter at what intervals revaluation was debated, as there would still be a running uncertainty about it and, inevitably, that would also arise in relation to an annual published assessment. I believe that we would have to live with an unceasing revaluation neurosis: will the revaluation be this year or next year?

Baroness Scott of Needham Market: My Lords, will the noble Baroness explain how that is different from the situation in which this Bill will leave us? A power is being given to the Secretary of State and at any time he or she may choose to exercise it. The point of the amendment is to tease out from the Government how we are to know. Will this be sprung on us out of the clear blue sky, or is it to be announced on the "Today" programme, as so many things are? How are we to know how the Secretary of State is thinking about this?

Baroness Andrews: My Lords, the difference is that the amendment requires there to be an annual debate on whether there will be revaluation that year. I cannot think of anything more destabilising for home owners than to have a debate which will run from year to year about whether there will be a revaluation. I shall come on to argue why I believe that the amendment is unnecessary; indeed, I believe that it is positively harmful.
	I am not simply being perverse in rejecting the amendment on the basis that I have just outlined. I am in total agreement with the need for a mature debate about the reform of council tax. However, I believe that the amendment carries a risk to the stability and credibility of the tax and I wonder whether there will be a risk of unintended consequences on house prices. I accept that the continuation of the council tax is not the policy of the noble Baroness's party, but it is the policy of the Government. We have to make it as credible and as watertight as possible.
	We have to address cost and bureaucracy. Those matters are not minimal or marginal. The real costs of mounting an annual exercise, which may well in certain instances lead to no revaluation, would be extremely high. Concerns have been expressed not only by me in Committee, but also by the Opposition Front Bench in the other place, when Mr Syms said that,
	"there is always a danger of insisting on members of the civil service doing a lot of work that does not necessarily need to be done".—[Official Report, Commons Standing Committee A, 15/11/05; col. 9.]
	He was supported by Mr Forth, who noted that,
	"to fulfil the requirements of the amendment, a gigantic bureaucratic exercise would have to be undertaken every year".—[Official Report, Commons, 1/12/05; col. 474.]
	Those are serious considerations. Would that obligation to produce an annual report provide value for money for taxpayers? It might be argued that there is no specific requirement within the amendment that the work required should be particularly expensive, onerous or arduous. However, if the work were not properly done—and to do it properly would require significant investigation every year of matters such as the state of the housing market and a proper analysis of the options and so on—there would not be much point in doing it.
	If we lay that objection to one side, I am bound to say that I see no real justification for the amendment. This would be a statutory requirement to provide specially for a mechanism to require the Government to pronounce in a particular way on a single area of policy, but we do not have a provision with comparable effects in relation to a long list of other areas of policy. For example, I am thinking of the effects on individual citizens of the Budget or the setting of benefit levels.
	That brings us to the nub of the argument. I know that the noble Baroness feels that the Secretary of State might allow the situation to drift indefinitely or act without consideration for the need for public debate and that we might rush through the Lyons report without due parliamentary discussion. I hope that I can address her fears.
	The noble Baroness is also concerned about the potential for the unjustified use of the powers that will be given to the Secretary of State. Those powers relate to an issue of real concern to taxpayers. However, I do not believe that the argument leads to the conclusion that she has brought forward. I believe that it is a question of trust in the system and in the responsible office and person of the Secretary of State. Despite the superficially attractive argument for explicitly providing for regular review and explanation, this House surely, on further reflection, cannot accept its validity. Ministers are accountable for their decisions every day of the week, 365 days a year. They are held to account in a variety of ways by mechanisms that ensure that they act with probity.
	What is the logic of the amendment? These are not entirely new powers; the power of the Secretary of State to bring forward a revaluation within a 10-year timeframe was set out in the previous legislation. All the Bill does is to place that power within a more flexible timetable to signal that we are committed to postponement. Why should that change be singled out for this kind of special treatment? If we legislate for an annual review of revaluation, where logically would we stop? Furthermore, the powers of the Secretary of State are hardly unfettered. As I have already described, they are subject to the affirmative procedure in another place. The proper time for the next full debate is not at some arbitrary moment during the course of every calendar year, but when an order is on the Table with a date for revaluation and a co-ordinated packet of reforms to go with it. Let the noble Baroness be in no doubt that we will have that debate.
	The noble Baroness has implied that decisions on revaluation might be taken in isolation and without reference to public interest. I shall not go into detail, but the point of postponing revaluation from 2007 was to introduce greater certainty, clarity, transparency and rationality into the debate so that future revaluation would be based on a greater and more credible understanding of the functions of local government and the services that it provides. If the noble Baroness reads the interim report, she will see what Sir Michael Lyons says about this. The landscape of local government has greatly changed. To extend the remit to include that while at the same time looking at the revaluation system was logical and transparent. I hope that that is reassuring.
	There is a further argument, which is about the need to provide Sir Michael Lyons with time and space to complete his work and for us to consider and consult on it. This was not a capricious decision. His work, and the whole context of revaluation, must be considered in relation to those who design and deliver services in local government. We have a strong, robust and continuing relationship with local government through the Central Local Partnership. That signifies our intention, which we always express, to work with local government in order to strengthen and sustain it. The relationship is based on trust and partnership. In the light of that, I can reassure the House that our approach to local government finance in the light of Sir Michael's findings will be based fairly and squarely on proper, full, public debate. I hope that the noble Baroness will accept those arguments and will feel able to withdraw her amendment.

Baroness Scott of Needham Market: My Lords, I am grateful to the Minister for that full reply. The amendment that I tabled in Grand Committee was a probing amendment to achieve a greater understanding of how the Government are going to decide when the Secretary of State will use the power given to him in the Bill. I wanted to understand what factors the Secretary of State will take into account when determining whether to revalue and what framework he will use to decide whether the time is right. We must always remember that the longer we stay with the present valuation system, the more discrepancies there will be, and that there is at least an equal effect and impact from a decision not to revalue as a decision to revalue.
	What I was seeking to do was to understand. My disappointment is that, both in Grand Committee and today, the Minister has concentrated on what she sees as the flaws in my amendment, rather than taking the opportunity to give me the reassurance that I felt I needed in order to understand these processes. I rather think that she has not done that because she cannot, which brings us back to our basic problem: we have dealt with this Bill in an isolated way, particularly from the Lyons review but to a lesser extent from the Miliband review. I think that it is that detachment which is causing us so many of the problems, because we have a sense that we are taking a step into the dark. We do not know where this is leading, which is causing us to be nervous.
	However, I shall not press the amendment to a vote today. My concerns are on the record and I hope that the Minister and the rest of the House will accept them in the spirit in which they were expressed. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Hanningfield: moved Amendment No. 4:
	Page 1, line 17, at end insert—
	"( ) In subsection (11), for "House of Commons" substitute "each House"."

Lord Hanningfield: My Lords, in another debate, the Minister rejected this amendment on the ground that it is not within the remit of this House to vote on matters of taxation. Indeed, she quoted Erskine May on this matter, which states:
	"If the subject matter is taxation, the required resolution will be that of the House of Commons only".
	That may be so; noble Lords would not expect to be involved in financial decisions. However, we feel that the decision whether to hold a revaluation is not a financial matter. Nothing about the Bill touches on taxation; it reorganises the order of financial procedure in local government. Indeed, we have been told several times that it will be financially neutral anyway. What is more, the whole process will not only have a profound effect on the levels of council tax, in a secondary sense, but it will have a huge effect on the arrangement of local government as a whole.
	I was grateful to the noble Baroness, Lady Scott of Needham Market, for supporting this amendment at an earlier stage. In the light of united opinion on this matter, I look forward to the Minister's reconsideration of it. I beg to move.

Baroness Scott of Needham Market: My Lords, as the noble Lord, Lord Hanningfield, has said, I offered my support for this amendment in Grand Committee, and I am happy to continue to do so. I have very little to add to what I said then. I do think that this is a matter of public policy. It is a matter of principle rather than detailed financial argument, and it is therefore perfectly in order for both Houses to consider this statutory instrument. I believe, given its importance, that it is essential that both Houses have the opportunity to do so.
	I want to make it clear, as a member of the Delegated Powers and Regulatory Reform Committee, that that committee was not offering some kind of endorsement of the procedure laid out in the Bill; given that the original Act provided for privilege to apply to the case for revaluation, it was simply content for that to continue. From my point of view, as I said when I spoke to the previous amendment, it is the removal of the certainty of the 10-year period within which revaluation had to take place that moves us into a different ball game. If the Secretary of State is to have a power to revalue at any time, but more importantly if that power extends some time into the future, it is important that that power, when exercised, is scrutinised by both sides of your Lordships' House.

Baroness Andrews: My Lords, I am grateful to the noble Lord for allowing us another opportunity to debate a very important amendment. He has argued that it is only by having the power to debate changes to council tax revaluation in this House, as well as in the other place, that the powers of the Secretary of State can be held in check. The amendment may appear to be rather limited, but its effect is fundamental, which I hope to be able to show. It clearly covers much wider concerns. I did my best to address the issues in Committee; I am afraid that I will have to use some of the same arguments and even some of the same quotations, but I hope that they will be more convincing this time.
	Let me deal with the widest point first—the right and the ability of this House to debate changes in local government finance and organisation. The noble Lord and his party are concerned that this House should have the opportunity to debate anything that may follow from any of the current debates concerning the form, function and funding of local government. Let me give him that assurance. Although he did not raise this argument specifically, it is still worth putting this on the record, because I want to reassure noble Lords about the nature of the debate we intend to have on these wider issues of local government and finance.
	We are engaged in a very open and public debate on these matters with local authorities and all manner of experts, not least the noble Lord, Lord Hanningfield, himself, and the Local Government Association. There is a very wide consultation process on the Lyons report. I made it clear in Committee that the Government have said that a White Paper will be published in the summer which will draw together these discussions on a wide-ranging set of issues. That White Paper will of course be open to debate in this House.
	Any primary legislation that may follow will require our full and constructive engagement. Equally, I give noble Lords the assurance that this House will have an opportunity to debate any findings or recommendations that arise from the Lyons inquiry involving changes to do with council tax revaluation and anything else within the scope of his work. We cannot anticipate the form that implementation may take, but with so much experience in this House, we want noble Lords to be involved. That is the context in which the amendment has been proposed. That was part of the argument we had in Committee and I wanted to make this clear.
	This amendment is not the right way to go about achieving its objective. It would extend the order-making power to set the date of revaluation from being subject to affirmative procedure in the other place to being subject to affirmative resolution in both Houses. There are two arguments against the amendment which I believe are conclusive. First, on the point raised by the noble Lord, Lord Hanningfield, to set a date for revaluation is essentially to start the cycle of raising local taxation on a revised basis. To insist that this House should have the same powers as the House of Commons to challenge that process is to overturn the historic convention that these powers rest with the House of Commons alone.
	I brought the relevant section of Erskine May to your Lordships' attention in Committee. It says:
	"If the subject matter of the instrument is taxation, the required resolution will be that of the House of Commons only".
	As the noble Baroness, Lady Scott, who is a member of the Delegated Powers and Regulatory Reform Committee, pointed out, we have the benefit of a clear opinion in its 12th report of this Session. It was quite specific in its acceptance of the appropriateness of the procedure. Paragraph 6 of the report states:
	"As a matter of delegated powers, that is not inappropriately wide".
	Crucially, in paragraph 7, the committee confirms:
	"The privilege of the House of Commons extends to raising money by local, as well as national, taxation (except when it waives privilege) and revaluation feeds directly into the amount of tax raised".
	That is a very clear statement; I do not know how it could have been clearer. The noble Baroness will know that it would be unusual and, I believe, inappropriate, to overlook or contradict that advice. The committee concluded by confirming that there are no issues for the attention of the House.
	The second argument is one of consistency. If we extend the power in this way, we are being inconsistent with the history of the legislation which precedes it. The powers which the Bill provides for the setting of a date is simply a variation on the previous date-setting power in Section 22B the Local Government Finance Act 1992 which, with the agreement of this House, gave the Secretary of State the power to set a date at any time within a 10-year cycle. That power was subject to the affirmative procedure in the other place only. There is every reason in terms of consistency, practice and logic why this power should follow what has been voted on and agreed by both Houses and laid down in legislation.
	Once again, the Delegated Powers and Regulatory Reform Committee is helpful on this point, saying in paragraph 6:
	"The affirmative procedure is also appropriate: it is the procedure to which orders under the current section 22B (which may provide for more frequent valuations than every 10 years) are subject".
	Furthermore, this amendment breaks precedents that go beyond just Section 22B. No other powers in the Local Government Finance Act 1992 are subject to affirmative resolution here. I hope that noble Lords will understand that I take these amendments seriously. I have offered the best evidence I can find that they are inappropriate. I hope that the noble Lord will withdraw his amendment.

Lord Hanningfield: My Lords, I thank the Minister for that reply. She knows that I will be disappointed. I want to stress, as I began, that we do not—and I would have thought other noble Lords would not either—see it purely as a taxation matter. It is a matter that concerns almost the future of local government as we now know it. It is such a political issue that it is a matter of considerable public concern. Therefore, one is extremely disappointed that just because of the 1992 legislation, which was a different issue—a new type of taxation—now there is public concern about the future of council tax and the way in which local government is going to continue. I am extremely disappointed to hear the Minister's answer.
	One of the fortunate features of Grand Committee is that because one cannot vote there one tends to repeat many of the issues on Report. I am sure that we will do that at Third Reading. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Health Bill

Lord Warner: My Lords, I beg to move that this Bill be now read a second time.
	It is a privilege to have the opportunity to bring such an important and indeed historic Bill before the House. The Bill contains a diverse range of provisions aimed at protecting the health of the public both inside and outside of hospital as well as improving the management and efficiency of the NHS.
	I will start with the smoke-free provisions. We have come a long way in recent years, but smoking is still the principal cause of premature death in England. An estimated 85,000 people die every year from smoking-related illnesses, including lung cancer, respiratory illness and heart disease. The estimated cost to the NHS in England alone of treating people with smoking-related diseases is between £1.4 billion and £1.7 billion per year. Only last week research published in the European Heart Journal showed that the UK spends the highest proportion of its healthcare budget on treating cardiovascular diseases of any country in the European Union.
	However, we are tackling head-on the problem of smoking. We have already banned tobacco advertising. We have strengthened health warnings on cigarette packets and we have introduced NHS stop-smoking programmes that in 2004–05 alone helped almost 300,000 people give up smoking. With this Bill, from the summer of 2007 virtually all workplaces and enclosed public places, including all licensed premises and membership clubs, will be smoke-free. This will be a major step forward. Not only will we be protecting people from the well documented dangers of second-hand smoke, we will be creating an environment in which smokers will find it easier to give up.
	Of course noble Lords will be well aware of how the smoke-free provisions in the Bill have evolved during its passage through the other place. Indeed, no doubt many of your Lordships will see the changes made by the other place as an interesting reversal of roles. I do not intend to dwell on that point other than to say I hope that this House will respect the divisive—I mean, the decisive—vote—

A noble Lord: A Freudian slip.

Lord Warner: These always creep in, my Lords.
	I hope that the House will respect the vote—indeed, it was a free vote—in favour of extending the smoke-free provisions to both licensed premises and private membership clubs. I believe the comprehensive smoke-free legislation that the House will now consider was not just the best outcome in public health terms but also the best outcome in terms of representing the strong public support there is for a total ban. A December 2005 opinion poll commissioned by Cancer Research UK and the public health charity ASH revealed that over 70 per cent of respondents supported a total ban on smoking in public places and workplaces.
	Noble Lords will no doubt also be aware of the strong support the full ban has with those who see at first hand the harm that smoking causes. For example, Professor Dame Carol Black, president of the Royal College of Physicians, said:
	"The ban will lead to up to a million people quitting smoking and in the long term thousands of lives will be saved. The UK now recognises smoking as one of our greatest avoidable threats to health and accepts the need to manage it effectively. There are still more measures to be taken and we urge the Government to continue along the path of effective tobacco control. We shall be with them at every step".
	The BMA's head of ethics, Dr Vivienne Nathanson, said:
	"Every day around 30 people die in the UK as a result of second hand smoke. Yesterday's vote will mean the beginning of the end to these frightening statistics".
	Professor Alex Markham, Cancer Research UK, said:
	"This is the most important advance in public health since Sir Richard Doll identified that smoking causes lung cancer 50 years ago".
	Lastly, I quote Mr Peter Cardy, the chief executive of Macmillan Cancer Relief, who said:
	"We are delighted that Parliament has seen sense and has taken the single most effective step it can to cut horrible, painful lung cancer deaths. As Macmillan Cancer Relief knows only too well, smoking and passive smoking cause nine out of 10 lung cancers. This move will, quite rightly, protect the health of staff working in pubs and membership clubs as well as their patrons".
	This is truly an important and historic Bill. Through the smoke-free provisions, thousands of lives will be saved every year and many thousands more people will be spared the misery of watching friends and family die prematurely. Hundreds of thousands of people will be helped to give up smoking and to take back control of their own health. And millions more will be protected from the dangers of second-hand smoke in virtually all enclosed public places.
	Before moving on to the other important provisions in this Bill, I turn briefly to Chapter 2 of Part 1 of the Bill. Here, we have taken a power to enable us to raise the minimum age for sale of tobacco products through secondary legislation. On 8 December 2005, my colleague, Caroline Flint, the Under-Secretary of State for Public Health, announced the Government's plans to hold a full public consultation on whether the age for sale of tobacco products to children and young persons should be raised from the current minimum age of 16. However, discussion of this issue in the other place during the passage of the Bill revealed cross-party support for the Government taking a power now, in the Health Bill, to enable the minimum age to be raised through secondary legislation at a future point. This will enable the Government to take swift action should change be deemed desirable in the light of the consultation without the need for further primary legislation. This consultation will begin shortly.
	Part 2 of the Bill reinforces the measures that we have taken to tackle healthcare-associated infections. I know that this issue remains a key public concern and patients quite rightly expect to be treated in a clean and safe environment. Not all of these infections can be prevented, but minimising healthcare-associated infections is a top priority. That is why we have set a target to halve MRSA bloodstream infections by 2008. We were the first government to require surveillance for MRSA and we are using this data to help drive down infection rates. These actions are beginning to have an effect and some specialist hospitals have shown particular progress. But we are not complacent. The provisions in this Bill build on the progress to date and will further sharpen the focus on infection control in the following ways.
	First, the new provisions will enable the Secretary of State to issue a code of practice on healthcare-associated infections which will be legally binding on any English NHS body. The code is based on existing best practice, and a draft was well received when it was consulted on earlier this year. Copies of the latest version of the draft code are in the Library.
	Secondly, we will back this up by giving the Healthcare Commission new duties to ensure that the relevant NHS bodies observe the code. Thirdly, where the commission feels the code is not being properly observed, it will have the power to serve an improvement notice where it judges that this is the most appropriate course of action.
	Finally, if there are significant failings in the provision of healthcare involving performance against the code, the commission will be under a duty to report this to the Secretary of State, and to monitor in the case of NHS foundation trusts. The commission may recommend that we take special measures to remedy the situation. The measures we decide to take in response to a report could range from practical assistance, such as drawing on the support of a trust that has successfully implemented the code, to more formal intervention at board level.
	The provisions in the Bill will build on existing good work to give a firm statutory footing to good practice in infection control and hygiene practice in the NHS. We will have clearer direction and tough sanctions for trusts that fail to deliver. I am confident that the code and the new powers for the Healthcare Commission will ensure that patients receive the quality of care in this important area that they rightly expect. I note that the Opposition health spokesman in another place, Andrew Lansley, emphasised at Third Reading the necessity for the measures described in the code.
	Part 3 of the Bill deals with drugs, medicines and pharmacies. This includes provisions to strengthen the management of controlled drugs throughout the UK, in response to some of the shortcomings identified by Dame Janet Smith in the Shipman inquiry's fourth report.
	Many improvements in clinical governance have already taken place since Shipman was practising, but this legislation will bring a greater focus to the management of controlled drugs in particular.
	The Bill gives every healthcare body a duty to appoint an "accountable officer" to take personal responsibility for the use of controlled drugs within that organisation. There will also be a new duty on all NHS bodies and relevant local organisations to share intelligence and agree joint action where there are concerns about the misuse of controlled drugs. I am confident that this legislation will strengthen the safeguards against that very small minority who would divert these drugs for personal abuse, financial gain or, in a few rare but extreme cases, criminal purposes.
	The remainder of Part 3 and Chapter 1 of Part 4 of the Bill deal with pharmacies. It has long been recognised that we are not making best use of the pharmacy workforce, particularly in community pharmacy. To address this, the provisions in this Bill will free pharmacists throughout the UK from the dispensing bench so they can expand the range of services that can be provided from the pharmacy. There are services that can add real value to the health of the community, such as advice on smoking cessation or medicines-use reviews for patients with long-term conditions. And we know from our "Your Health, Your Care, Your Say" consultation just how well regarded our community pharmacists are, and that many people really appreciate the advice and help pharmacists can give.
	At the same time as freeing up the pharmacists, we are also reforming the entry requirements for the provision of pharmacy services across England and Wales. The Bill implements the final elements of a balanced package of reforms for England in response to the Office of Fair Trading's 2003 report on the restrictions on NHS pharmacy applications known as "control of entry".
	I read with interest the debate in the other place on the ophthalmic provisions in this Bill. Quite rightly, there was acknowledgement that we have some of the best ophthalmic services in the world. But there was some concern and misunderstanding that the provisions in this Bill are seeking to tamper with this excellent service. This is not the case. What we are seeking to do is remove restrictions on whom PCTs can contract with to provide the sight-testing service to reflect the reality of service provision and help to facilitate market entry.
	Secondly, the new framework for ophthalmic services will also permit the commissioning of enhanced services or additional services—the type of services that are often available only in the less convenient secondary care setting, but doing this within the community setting. That is what our review of ophthalmic services is looking at: how we can make better use of the skills and resources in the primary care setting. The provisions in this Bill simply provide a new framework for such services to be provided. While PCTs have some powers to commission enhanced services, we think that a more coherent and flexible framework, such as that used for other primary care services, will support that activity and help PCTs to deliver better care for patients. In particular, there will be powers to require the provision of additional ophthalmic services across England. The new framework clearly provides opportunities for primary ophthalmic providers to provide a much wider range of services. Currently, the 1977 Act provides only for the commissioning of the sight-testing service.
	I know that there are concerns about whether the new framework will mean that we move away from the current nationally negotiated contract and central funding arrangements for the sight test. On that point, I reiterate what my colleague, Caroline Flint, said in the other place. We have no intentions to move away from how the sight-testing service currently operates; in other words, patients will be able to choose their general ophthalmic services contractor and contractors will be able to have a general ophthalmic services contract, provided that they meet agreed national criteria, subject, as now, to local decisions on matters such as quality of service. We also plan to continue to have a centrally negotiated and funded sight-test fee with access to sight tests not being constrained by individual PCT budgets. These provisions will help PCTs to deliver better outcomes, more choice and even more convenient ophthalmic services for patients, and provide a real opportunity for providers of primary ophthalmic services.
	I turn to the protection of the NHS from fraud. The Bill will give the NHS Counter Fraud and Security Management Service modest new powers to continue to fight fraud in the NHS and to make it a safer place to work. The counter-fraud service has been highly successful in ensuring that money provided for provision of healthcare services in the NHS is spent as intended and not lost to fraud. By the end of the last financial year, it had produced a financial benefit of £675 million, which represents a 13 to one return on its total budget since 1999. Its role in deterring fraud is considerable. The new provisions in the Bill will simply enable the counter-fraud service to require the production of documents relating to specific investigations, such as asking for the pay records and duty roster of a private care home when an NHS employee has been working while also claiming sick leave from an NHS trust. It will not include powers of entry, search, seizure or arrest. In that respect, the counter-fraud service will continue to be supported by the police.
	The last substantive part of the Bill is Part 5, which will establish a new non-departmental public body, the Appointments Commission, to replace the current NHS Appointments Commission. These provisions respond to the Public Administration Committee report in 2003 on Government by Appointment. The committee found that the NHS Appointments Commission was working well and that other government departments could benefit from using its services. This Bill provides the legal framework to do just that and reconfirms our commitment to an independent appointments process.
	There are also a number of minor and technical provisions in the Bill relating to the administration of the social care bursary scheme; the audit arrangements for special health authorities; the injury cost recovery scheme in the NHS; the transfer of criminal liability in the NHS; and provisions to remove out-of-date references to Welsh health authorities. I shall not go into any further details here.
	In conclusion, this is an important and wide-ranging Bill that will have a tangible impact on the health of the public both inside and outside the hospital setting. It will remove tobacco smoke from virtually all the country's enclosed workspaces, leading to an estimated 600,000 fewer smokers, more lives saved, and up to £100 million per year in savings to the NHS. It will better protect patients from healthcare-associated infections; modernise the provision of pharmacy services, ensuring we make best use of pharmacists' skills; give our counter-fraud service enhanced powers to target those who defraud the NHS; and it will make a number of technical changes to improve the working aspects of health and social care. I commend the Bill to the House.
	Moved, That the Bill be now read a second time.—(Lord Warner.)

Baroness Cumberlege: My Lords, I declare an interest: I chair St George's, University of London, I am a trustee of Cancer Research UK, and am involved in a number of health-related organisations and charities through my company, Cumberlege Connections. I start by thanking the Minister for his very clear exposition of this Bill. It is a complicated Bill. He described it as "diverse", and I agree. It has something like nine component parts. Sadly much of what is in it is to be left to regulation. Like him, though, I believe there are elements in the Bill that will have a tangible impact on the positive health of the nation, but of course there are other elements that will need robust scrutiny and debate. As is customary in this House, we will seek to amend and improve in weeks to come.
	Sir George Young, when a junior health Minister, coined the memorable phrase that a decision at the Cabinet table could do more to improve the nation's health than an incision on the operating table. Yet the Cabinet has had real problems in reaching a decision on smoking. It has been for individual Members of Parliament to decide, and I have no quarrel with that. It is right that in this House we should also have a free vote.
	It is perhaps surprising that it has taken over 50 years of compelling research to bring Parliament to consider whether smoking should be banned in workplaces. For me the hero in all this has been the remarkable Sir Richard Doll, who sadly died last year. This is neither the time nor the place to laud the great man, but I remember his survey of family doctors when I was a child. My chain-smoking father was a participant. He was so convinced by the results that he quit smoking. He urged his patients to follow suit, but the majority were totally unconvinced, and did not.
	The medical profession believed the research was so compelling that the public would need no further persuasion; they would be convinced and stop of their own accord. Some did, of course, and the reduction from 45 per cent of the population who smoked in 1974 to today's rate of 25 per cent is progress, albeit small. What is a concern, however, is the number of teenagers who smoke: 26 per cent, and their number is increasing. Teenagers are not worried by their own mortality, a distant concept, but are obsessed by image, which is of immediate concern. We know that once they have started, it is very hard for people to stop. This Bill, with its emphasis on banning smoking in workplaces, turns smoking from a social activity into an activity for loners—hopefully not a cool image, but one to be rejected by teenagers.
	Having read the brief from FOREST, I have no doubt there will be a debate on the legitimacy of the science. That is inevitable, and robust questioning is healthy. To my mind, however, the two reports of the Department of Health's Scientific Committee on Tobacco and Health are overwhelming in both their evidence and conclusions. I am convinced that second-hand smoke kills; ventilation does not work; smoke-free legislation helps reduce smoking prevalence and does not increase smoking in the home; a comprehensive law would reduce health inequalities; private members' clubs are workplaces too; exemptions discriminate against workers and could lead to legal challenges; partial legislation is unfair, unjust, inefficient and unworkable; a comprehensive smoke-free law will provide an even playing field for business; the public supports going smoke-free; and a smoke-free UK makes sense. My reservations in this part of the Bill are purely aesthetic: they concern the rash of notices that will deface every building. I hope that we will be able to enforce the law with a degree of consent and without plastering every available building with another, bossy, unsightly notice.
	Part 2 is entitled "Prevention and Control of Health Care Associated Infections". Traditionally hospitals have been seen as places for cure, treatment, therapy and respite; places of compassion and care. Today they are seen by some as frightening places, places that harbour hospital-acquired infections. For some people, hospitals are now scary places, to be avoided if at all possible. MRSA is probably the best-known of the superbugs, but we should not ignore the other organisms, such as Clostridium difficile, VRE and Acinetobacter which are causing increasing problems. These and other infections have been emerging over recent years at the same time as initiatives have been under way to try and combat the spread. The Government have been slow to act and the problem has got and is getting worse.
	We have some of the highest rates of MRSA in Europe. The financial cost to the NHS is estimated to be in excess of £1 billion a year. But the cost to individuals and their families is beyond measure. In 1978 Clostridium difficile—C.diff—was first linked to making the elderly sick in hospitals. In Canada, about five years ago, C.diff mutated and started to kill patients, younger people. This new hyper-virulent strain has spread down the east coast to the US and has also arrived in the UK. Stoke Mandeville Hospital was the first British hospital to admit publicly to having the strain, which was linked to a number of deaths. This C.diff mutation should be a salutary lesson to us. If a similar mutation was to happen to MRSA and if it were to become resistant to Vancomycin, the antibiotic used to treat MRSA—if VRSA were to get a hold as MRSA has, in the vernacular, we would not have seen anything yet and there would be widespread deaths in hospitals.
	One of the contributory factors to the spread of hospital-acquired infection has been bed over-occupancy. My recent experience when visiting a relative in a private hospital was that every bed was left empty for 24 hours after the patient was discharged and then thoroughly decontaminated. Not so in the NHS, where beds are "hot beds", re-occupied while still warm, which means that the waiting list targets are met in the short term, but it builds problems in the longer term. The Government should view the wider picture and relax some of their targets in the interest of safety and good clinical management.
	I welcome the introduction of a code of practice and the involvement of the Healthcare Commission in its enforcement but I hope that the Minister will take into account the continuing concerns of the RCN as to the scope of the code and give organisations a further opportunity to debate and improve it before the Bill receives Royal Assent. Likewise, the definition of a healthcare-associated infection needs reconsideration.
	Parts 3 and 4 of the Bill have proved controversial. The Royal Pharmaceutical Society has concerns, as do optometrists. I would like to leave the pharmaceutical issues to Committee stage, but regarding the changes to the General Ophthalmic Services the question is: why do the Government want to change an arrangement which works so well at the moment? I have listened to what the Minister has said, but there is still a strong belief that, if the Government allow primary care trusts the powers to limit the availability of NHS sight tests, there is every likelihood that the service will be put at risk. As the Minister has quoted, during the Commons Committee stages, clear promises were given that regulations would be introduced to effectively stop the Bill damaging the service. But it still begs the question why these clauses are in the Bill at all. They put at risk genuine choice for patients, no waiting lists and an opportunity to increase standards.
	Alongside the negative aspects of these clauses there is also a positive side. The Bill allows for an expansion of the service to deliver in England what Scottish and Welsh patients can already enjoy, and I really welcome that.
	Those are not the only aspects of the Bill that I think need consideration; as always, other parts require amendment and improvement. I look forward to a lively Committee, a stringent Report stage and a crunchy Third Reading debate.

Baroness Barker: My Lords, I too thank the Minister for introducing the Bill. At last your Lordships have the opportunity to consider in detail the Health Bill—not the Health Improvement and Protection Bill as it was originally entitled. Clearly, the part of the Bill that has attracted the most attention in the other place is Part 1, dealing with the ban on smoking in enclosed public places. More observant noble Lords will have noticed that my noble friend Lord Clement-Jones, who is part of our DCMS team, is back on a free transfer to the health team because he took the tobacco advertising Bill through this House very successfully and therefore has some form on the subject. I should like simply to make two points and to leave most of the other matters to my noble friend.
	The first is that the smoking ban is a matter of considerable public interest and one on which there has been extensive and well informed public debate. Public opinion, not least as it is reflected by the number of commercial companies that have already introduced voluntary bans, is quite clear and in some respects ahead of Parliament. Should there be a difference between the two Houses on the matter of a ban, I believe that the views of the elected Members of another place should take precedence. I do not believe that this is a matter on which this House has the right to overrule those down at the other end.
	Secondly, this is a matter of public health. The role of government should be to protect individuals who for whatever reason cannot exercise free choice about whether to work or to be in a smoke-free environment, and to address health inequalities. That will be the basis of the Liberal Democrat contribution to this debate and it reflects our policy on the matter.
	I too wish to concentrate on the other parts—the anorak parts—of the Bill, which have received very little attention. However, these parts have important consequences for primary and secondary healthcare.
	The most substantial part of the Bill, as the noble Baroness, Lady Cumberlege, said, is the introduction of a code for infection control. The incidence of infection in healthcare settings has been the subject of extensive political debate, not least during the previous general election, which proved conclusively that the public were not thinking what the Conservatives were thinking. The second national prevalence survey of infection in hospitals, in 1996, estimated that 9 per cent of all inpatients had a healthcare-associated infection. The National Audit Office report in February 2000 reported that healthcare-associated infections were possibly responsible for up to 5,000 deaths per year and the associated cost was £1 billion per annum. Since then there have been a number of initiatives, mostly information and education materials for healthcare professionals, such as Fighting Infections, Winning Ways, Towards Cleaner Hospitals and, in June 2005, the NHS Modernisation Agency's infection control initiative Saving Lives
	Given all that activity, the fundamental question which the House has to ask is what difference will be made by a code of practice that, by the Government's own admission, will place on the NHS a regulatory burden of £34 million annually. When making up their minds, noble Lords might like to consider that the Bill's regulatory impact assessment makes clear that the data on which the code are built is from 1997. Moreover, in the intervening period there has not been a fully reliable system of surveillance of incidence of infection, nor of the implementation of infection control practice within hospitals.
	Perhaps the greatest concern is that there is a dearth of information about the effectiveness of different infection control measures. There is evidence that infections transmitted by hand can be countered by the use of alcohol rubs, and infections in catheter care, which are extremely prevalent, can be reduced by the introduction of aseptic non-touch techniques. In addition, programmes such as UCLH's screening of all patient admissions has worked well, in that it has identified the prevalence of MRSA in other environments such as care homes. One wonders whether greater investment in pilot projects such as that and the eventual roll-out of successful infection control techniques would represent better investment of resources.
	Furthermore, one must ask whether the penalties for non-compliance with the code of practice will simply lead trusts to divert their resources from other means of fighting infection—such as high standards of laundry, ensuring that staff have changes of uniform and facilities in which to change, and 24-hour cleaning services. The noble Baroness, Lady Cumberlege, gave an example; I shall give another. A few years ago, a friend of mine who was in a major London teaching hospital went for a bath and returned to find that her bed had been given to, and was occupied by, another patient. Bed occupancy rates are extraordinarily high in some of our major hospitals. We do not want another lot of centrally set targets that are of no use to front-line staff in trying to combat problems as they meet them.
	A number of organisations have commented on the limitations of the proposals. The RCN has criticised the definition of healthcare-associated infection within the code of practice. That organisation states:
	"The definition as currently drafted appears to confuse what a HCAI is with how you come to acquire such an infection".
	That is an important distinction when one is attempting not just to identify but to control infection. Many organisations have criticised the fact that the code of practice will not apply to non-NHS facilities such as independent care homes. That is remarkable, given the incidence of MRSA among care home residents.
	Our policy has been to give those in the front line the support and freedom of action to do what is necessary to fight infection where it occurs. We would ensure that information and training would be available to all staff to enable them to implement effective good practice. Staff would have discretion to close wards or set up isolation units as necessary. We would also ensure that effective systems of feedback and monitoring were in place, so that a sound evidence base of practice could be built.
	In 2003, the Government gave £12 million of pump-priming money to pharmacists to set up a system of surveillance of the use of antimicrobials. That money is coming to an end and I would like to know whether that extremely successful project will be extended.
	Our view is that a code of practice, which is to be introduced immediately, whether trusts are ready or not, and which focuses on processes rather than outcomes, is likely to be of limited use; but we accept it as far as it goes.
	The new measures on supervision and management of controlled drugs are to be welcomed in that they incorporate many of the findings of part four of the Shipman inquiry. No system should be designed on the basis of the actions of one extraordinarily evil man; however, reform is necessary. We welcome the proposals in the Bill to the extent that responsibility for medicine management remains within organisations but wish to ensure that there are clear lines of accountability. We note the responsibility placed on the Healthcare Commission to review performance of each NHS organisation. However, I would also like to ask what role the Royal Pharmaceutical Society inspectorate will have in monitoring and policing the actions of NHS bodies. After all, that is the body with the relevant experience.
	The proposals to change the control on supervision of pharmacists, as the Minister has said, are the subject of some concern. Pharmacists do not simply fulfil prescriptions; they play a very important role in talking to patients and checking for adverse drug reactions, which are often not obvious until repeat prescriptions have been issued. To do that, pharmacists need face-to-face interaction with the people they serve. The proposal that registered pharmacists may oversee more than one pharmacy has caused some concern.
	We seek to scrutinise in detail the provisions on the review of general ophthalmic services. We are concerned that the Bill may limit access to general optometry, which is vital not just for eye care but for diagnosis of conditions such as brain tumours or glaucoma. Furthermore, we seek to probe exactly what constitutes additional and enhanced services under the GOS contract. Will conditions such as glaucoma be part of those additional and enhanced services?
	I have one minor question to the Minister. The administration of the social care bursary scheme is to be moved to NHS bodies. I am not clear from the limited statements in the Explanatory Notes why that is possible or necessary. Why should one discipline issue bursaries for another?
	With the exception of the smoking ban, this is not a strategic Bill. The noble Lord, Lord Warner, called it a diverse range of provisions. I would call it a collection of bits and pieces. It needs improvement and bits of it may well need protection during its passage through this House. Overall it has our support, but we will seek to strengthen it as it passes through your Lordships' House.

Baroness Masham of Ilton: My Lords, I thank the noble Lord, Lord Warner, for explaining this Bill so clearly. When the Health Bill appeared in the Printed Paper Office just before the half-term break, I thought, as I suspect others did too, "Not more changes to the National Health Service". But some of the additions in this Bill, such as restrictions on smoking, will be of great benefit to many people. Changes of membership of bodies and appointments to bodies, however, always seem to take the concentration away from direct patient care.
	Part 4 of the Bill deals with pharmaceutical services and makes changes to enable PCTs to consider, in their assessment of applications from pharmacists to provide NHS services over the counter, medicines and other healthcare products. It is the other healthcare products that I query. There is great concern that the Department of Health, having conducted a consultation exercise, is considering options for changing Part IX of the Drug Tariff. There are concerns about the proposals for change in the consultation on arrangements for the provisions of dressings, incontinence appliances, stoma appliances, chemical reagents and other appliances to primary and secondary care.
	The Patients Industry Professional Forum consists of medical professionals, patients and patient representative groups. Representatives from industry have been in touch with me. They say the consultation fails to acknowledge the demand for, and the necessity of, the essential services currently provided for patients by companies in this sector. Such services include the home delivery of appliances required by stoma and continence patients and the provision of specialist stoma care nurses, who care for patients by providing bespoke services such as the measuring and fitting of their appliances.
	The thrust of the Government's approach appears to be based on the opinion that the payment received by member companies that provide such essential services—known as dispensing appliance contractors, or DACs—should be the same as that received by high-street pharmacists, who do not provide such services. The members of the Patients Industry Professional Forum recognise that within the patient population will be many patients who wish to obtain their necessary prescriptions over the counter. However, for a large number of patients, such a service is impractical and inappropriate. Unfortunately, my husband is one such patient. The services provided by member companies in this area bring significant benefit to a sensitive part of healthcare, which much of the population does not understand and still finds embarrassing to talk about. New patients are recovering from the mental stress involved in facing up to serious illness, as well as the physical stress involved in recovering from major surgery. The support given by the specialist nurses is invaluable to carers, too.
	The Continence Foundation has also been in touch with me. It says that it hears that some PCTs are trying to make significant savings to the budget for continence products and that they are trying to withdraw delivery to people's homes and care homes. In a rural area, that would be totally impractical. On Friday, 17 February 2006, the headline of the Times read:
	"Thousands threatened by oxygen shortage. Woman dies as 'chaos' follows privatisation of vital NHS supplies".
	Surely we cannot continue with the Government telling us that it is up to individual PCTs. The public are worried about the fragmentation of these vital services. Do the Government and the Minister not want to protect these most vulnerable patients? We need some amendments to protect them and to make PCTs realise that they have a duty of care to provide these vital services.
	I am delighted with the progress in this Health Bill in making many premises smoke-free. All my life, I seem to have been trying to dodge smokers. For years, I have served on the board of visitors of a young offender institution. I have always felt that not enough has been done in health promotion in the Prison Service, especially with regard to the dangers of smoking. I ask the Minister to clarify the exemptions to smoke-free premises in Chapter 1, Clause 3. Will the Secretary of State for Health be able to make some specified areas in prisons and other institutions smoke-free? If prisoners who are non-smokers are banged up in a cell with a heavy smoker for long periods, that must be totally wrong now that the health evidence is so clear. Would it not be possible to make smoke-free wings in prisons and ban smoking in all eating areas and also in visiting areas, where there are often children and where staff are always on duty?
	I often interviewed young people who were non-smokers. Those who are trying to stop smoking should be given as much encouragement as possible. I hope that the Secretary of State will make appropriate regulations. I hope, too, that in care homes people who do not smoke are given a smoke-free environment to eat and socialise in if they so wish.
	Part 2 of the Bill introduces new provisions on prevention and control of healthcare-associated infections. I am pleased that this important part of healthcare is in this Bill. On 4 November 1996, I had an Unstarred Question debate on MRSA and infections that were resistant to antibiotics. The late Lord Fitt, who had recently lost his wife from MRSA caught in the Chelsea and Westminster hospital, spoke movingly, and the debate was well reported by the press. Since then, there have been several Select Committees and debates in both Houses of Parliament, and conferences throughout the country on infection control. Infection control is now firmly on the health agenda, and I am pleased that the Bill incorporates the issue. It is important to cover it by legislation. There are many different clever bugs—not just MRSA—not only in hospitals and other health facilities, but in the community. The public are now critical of dirty hospitals, and I am glad to say that the hand-cleaning campaign has now taken off, but not without a lot of hard work from many people working in the area of infection control, including the Royal College of Nursing with its Wipe it Out campaign.
	The Secretary of State will have the power to issue a code of practice, which I hope will include some basic needs. Only on Sunday evening, I was telephoned by a carer of a very disabled man. She said that his wife would not be given gloves that had been supplied to the carer for cleaning up the patient. He has 24-hour care, and has had MRSA twice. He has a peg in his stomach to feed him. To stop supplying such aids used for the prevention of infection seems unwise.
	I was told by a GP receptionist a few days ago that the NHS did not supply sterile swabs. Knowing that to be untrue, I told her that the NHS might be short of money but it had not yet reached that desperate state. GP practice receptionists should not be giving out false information. Otherwise people will not realise the importance of sterile procedures for vulnerable patients.
	There must be more training on infection control for everyone. I give those examples to illustrate what can happen at the grass roots. There are several areas in the draft code of practice requiring much greater clarification and definition. They include hospital design, staff to patient ratios, bed occupancy rates, isolation facilities, the timely management of patient care, clean air environment, hand-washing, and the correct clothing for medical and nursing staff—no rings, no ties—cleanliness of wards, beds, trolleys, curtains, door handles, and so on, and adequate laundry services. Clinical waste must be disposed of effectively and appropriately.
	Often there is a problem in the community. Infections can set in on a Friday or at the weekend. Doctors have to give a wide spectrum antibiotic instead of the most sensitive one for the infection, but the problem is that GP surgeries close on a Friday evening. If there were more testing facilities for infections of all sorts, with quick test results, fewer infections would become resistant to antibiotics.
	I am pleased that the Bill is trying to address the horror of Shipman, but with the increase in the number of elderly patients, there will be plenty for the accountable officer to do. There have been some disturbing cases in the north, with nurses abusing vulnerable patients with controlled drugs. The recent report on care homes and abuse through administering incorrect medication needs urgent attention. With so many demands and an increasing amount of patients of all sorts, I hope that the Government will not rob the most severely disabled people of their vital services. I hope that the Government will not forget that some patients need looking after even though the current message coming down from on high is that people should be capable of looking after themselves. There are some very concerned patients and carers who need reassuring. I hope that the Minister can give them that today.

Baroness Rendell of Babergh: My Lords, I speak today on only one aspect of the Bill—the subject of smoking. One important factor of the Bill is its timeliness. Perhaps it has even come a little late. When I stopped smoking, almost 30 years ago—I had gradually become a 40-a-day woman—I did so not because I was made ill by my addiction, but for social reasons and because, remarkably, I foresaw that at some time in the future—possibly many years, as turned out to be the case—smoking would become unacceptable and ultimately disappear from this country. I say "remarkably" because that is the only long-term prediction that I have ever made which looks like coming true.
	I remember saying to like-minded people that the time would come when only a few very old people would remain smokers. This no longer seems like a fantasy. The idea of a total ban on smoking no longer seems unreal; indeed, the media are already commenting on it as a fact, although the Bill has yet to pass through your Lordships' House. Will a total ban discourage addicts from smoking? The Department of Health has estimated that almost 700,000 will give up. A British Medical Journal survey concluded that workplace smoking bans reduced numbers by 4 per cent as well as cutting the number of cigarettes that people smoked—by no more than 1.3 a day, it is true, so my 40-a-day would have been reduced to only 38.7. To reduce through price, the British Medical Journal has estimated that the cost of cigarettes would almost have to double. Most of us who have no use for cigarettes will have noticed that, generally speaking, it is only non-smokers who comment on the cost. Smokers grit their teeth and pay.
	Smoking bans work. It seems, too, that they work without much of an outcry. Scandinavia has always seemed to me as if it would be the last bastion of smoking in western Europe, yet the Norwegians banned it in 2004, their aim being to protect those non-smokers among their citizens from second-hand smoke. Last summer, Sweden banned it, while allowing smoking rooms. The bans happened in both countries with scarcely a ripple of fuss. Ireland's ban, which the rest of Europe gloomily predicted would be unworkable, has been a distinct success. Since the 1960s, when I first began going to the United States, I have seen whole swathes of that vast country abandon smoking without fuss, so that it is possible to spend a week in a city there and neither see nor smell a single smoker. Bans were easy to enforce in New York and in California, and Montana saw a 40 per cent decline in the number of hospital admissions for heart attacks during a six-month smoke-free period.
	It is said by some that smoking should be left to people's personal choice. Leaving aside the question of whether someone under the sway of an addiction has any choice, what of the non-smokers? Until now, people with respiratory conditions or allergies have been denied all choice. The good done by a total ban will not be against their will nor will they grouse and grumble about a nanny state. Four-fifths of the country's 5 million asthma sufferers say that second-hand smoke makes their condition worse. Where are the civil liberties in compelling people to suffer others' smoke? In restaurants and pubs and clubs it has been compulsion for those who wish to keep their jobs.
	Smoke is not simply in the atmosphere that non-smokers breathe. A friend of mine who is a doctor of medicine told me that while he was working in the Royal National Throat, Nose and Ear Hospital the children with asthma and other respiratory problems almost invariably had a parent or parents who smoked. He could smell the smoke on those children, the result of their being hugged by loving parents who had perhaps been careful not to smoke in their children's company but whose hair and clothes still harboured the results of the smoke that they had absorbed. This is an aspect of passive smoking to which public attention has not previously been drawn.
	In one respect, the ban does not go far enough. When it comes, it will not, as we know, extend to royal palaces, prisons or residential care homes. Anyone who has been convinced of the reality of passive smoking will ask why not. Maybe those who live or work in the royal palaces—including this Palace—prisoners and elderly or incapacitated people approve of that exemption, but what of the staff? Choice is denied to them. Because of the relatively small spaces where smoking is allowed, one can be sure that there will be a concentration of smoke in the atmosphere. Librarians and catering staff in the case of your Lordships' House, prison officers and nurses and carers in residential care homes will be affected by it and, as we now know, will have their health damaged by it, but they need their jobs.
	More than 600 people die each year in the United Kingdom from second-hand smoke. Long before passive smoking was recognised as dangerous, a friend of mine in New York died of lung cancer. She was in her 50s. She had never smoked a cigarette, but had spent every day of her working life in a newspaper office where most people smoked. The ban will one day, I am sure, extend to these exempted areas. Perhaps it should even extend to people's homes if we remember asthmatic children, for whom normal breathing is difficult as a result of being hugged by their parents. We have been told that people's right to smoke in private places should be respected, but the health of children who have to live there and have no choice should be respected more.
	It has been said that when the ban comes into force more people will smoke at home than at present. That presupposes that those who now smoke in pubs and clubs will stay at home more. But people do not go out in the evening to smoke; they go out in the evening because they like going out in the evening, largely to enjoy eating and drinking in a convivial atmosphere. It is hard to imagine them giving up that habit to remain in an environment where they can smoke. On my way here this afternoon, my taxi driver told me that he did not smoke, but that his wife smoked heavily, which is a cause of dissent in the household. I asked him whether he thought that a ban in pubs and clubs would encourage her to smoke more at home. He said that it would have rather the reverse effect because of the opposition in his house to her smoking anywhere but out of doors.
	On the question of passive smoking, the rights of children are perhaps even more important than those of workers. Most of us would agree that children should have some say in the environment in which they are brought up, though few do. They should at any rate be protected, as they are in other areas of life, from activities which are now known to cause them harm. An all-embracing ban including people's homes is, however, a matter for the future, not the here and now.
	A ban with exceptions and exemptions, as we know, leads to abuses. Most of us know about pub licensees who, when licensing hours were heavily restricted, contrived ways of serving drinks to regular customers long into the night by establishing a "lock-out". So it might be with a partial prohibition on smoking, as those unwilling to give up their habit seek loopholes in the law. Moreover, ventilation is ineffective unless it is increased to gale levels, which would be unacceptable to most people.
	Scotland will go smoke-free at the end of this month, the National Assembly for Wales wants a comprehensive ban and comprehensive smoke-free legislation will be introduced in Northern Ireland. Medical opinion has for many years been in favour of the habit of smoking being abandoned and doctors will always tell patients that the most important step that they can take towards better health is to become non-smokers. Like the noble Baroness, Lady Masham, I ask my noble friend for some clarification on the exemptions to the ban.

Baroness O'Cathain: My Lords, a Bill of seven parts should encourage me to examine each of the parts with equal vigilance. In this case, I am sure that noble Lords will accept that it is not unsurprising that an ardent campaigner for a total ban on smoking in public places would spend most of the time considering Part 1, Chapters 1 and 2. This is not to say that the other six parts are neither fascinating nor interesting, or that they do not give rise to many questions. However, those of us who take part in Second Reading debates in your Lordships' House usually concentrate on the issues they feel most passionately about. As the Bill progresses through your Lordships' House, there will be opportunities to raise issues on other matters, not least, in my case, Part 2, which is on healthcare-associated infections, and Part 5, which is on the Appointments Commission.
	The Minister graphically described the effects of smoking on the health of our nation—600,000 deaths per annum from passive smoking is one—and he is right to say that the Bill will make a tangible difference. It has been a very long haul to convince the Government that we need—

Lord Skidelsky: My Lords, where does the noble Baroness get the figure of 600,000 from? I have never seen it. Even the most generous estimates do not put it anywhere near that.

Baroness O'Cathain: My Lords, I shall bat that one quickly to the Minister, who used it in his opening speech. The noble Lord was not present at the time.
	This is a pretty good trade-off for some limitation on smokers' freedom to smoke. Part 1 is entitled "Smoking", and contains little of which we are not aware. Members of the other place comprehensively made their views felt on a free vote, and many congratulations are due to them on placing the health of the whole nation before any sectional interests.
	This has been a long battle, but praise where praise is due. The events of 14 February made it all worth while. The honourable Member for North-West Leicestershire, David Taylor, deserves much credit for his tenacity and determination in getting at the truth about the effects of both smoking and passive smoking. The noble Lords, Lord Clement-Jones and Lord Faulkner of Worcester, and I had the great experience of going on a fact-finding tour to Ireland some 18 months ago under the leadership of David Taylor, and I can tell you that he worked assiduously and was determined to get to the truth about the effects of both smoking and passive smoking. The facts are incontrovertible; I plead with those who are still sceptics to research the literature and read the debates. The evidence of the huge detrimental effect of smoking on the health of all of us is overwhelming.
	This will be a short contribution. All I want to do at this stage is to flag up the issues which I think need further explanation and those that I think have been overlooked. First, will the Minister explain to us, either today or later in the passage of the Bill, what safeguards will be put in place under Clause 3(2) to ensure that the residents of care homes who do not smoke will not be subjected to passive smoking arising from the actions of residents who do smoke? The noble Baroness, Lady Masham of Ilton, mentioned this, as did the noble Baroness, Lady Rendell of Babergh.
	Similarly, what would be the position of visitors to care homes? Would they be subjected to the effects of passive smoking? Some visitors go to care homes to see their loved ones many times a week and sometimes spend many hours there. How will they be protected? Still on the same subsection, will university halls of residence be included as an exemption? I hope not. There must be sympathy for elderly folk in care homes who have smoked all their lives. When their lives are drawing to a close, it would be most unkind to deprive them of what they think is their only pleasure, or probably addiction. But students? No.
	Secondly—the noble Baroness, Lady Rendell of Babergh, also mentioned this—will the Palace of Westminster be an exempt area, or will every part of the Palace come under the law? Let us push for it. Finally, I have just three general points to make. I congratulate the Government on the provision in Chapter 2, at Clause 13(2), that the age specified in an order under subsection (1) may not be lower than 16. The Minister rightly mentioned this in his opening speech and I hope that the consultation will be even more positive.
	I heartily commend the Government for allowing a free vote on the subject of a partial or total smoking ban. I sincerely hope that we shall also have a free vote in this House. May I make a plea that we look again at the Irish experience and avoid one of the unforeseen consequences? When entering a restaurant, a café, a coffee shop or a pub in Ireland, one must inevitably go through a wall of smoke, a most nasty experience, which results in one's entrance being accompanied by coughing and watering eyes. There should be some way of putting a cordon sanitaire around the entrance to public places.
	I look forward to the Committee and further stages of the Bill and hope and pray that, on the issue of smoking, sanity will prevail.

Lord Patel: My Lords, I, too, thank the Minister for introducing the Bill. I strongly support it and, unusually, congratulate the Government, particularly on bringing in comprehensive legislation prohibiting smoking in all enclosed public places.
	I declare an interest: I am vice-president of the charity QUIT, which has helped thousands of people to give up smoking. Today's legislation will help hundreds of thousands more to give up and will go a long way towards meeting government targets for reducing the incidence of smokers in the population.
	I agree with the scientific evidence cited by the noble Baronesses, Lady Cumberlege, Lady Rendell and Lady O'Cathain. Anybody who does not agree with the overwhelming scientific evidence of the damaging effects of second-hand smoke has his head in the sand or is confused by facts.
	I am pleased that the Bill was amended in the other place to remove the opportunity to exclude private membership clubs and any licensed premises. All public places should be smoke-free, including all areas of the Palace of Westminster. I would go further: Parliament should set an example, as have hospitals, and ban smoking in all parts of the Palace of Westminster, including offices. I support these measures.
	Part 2 relates to the prevention and control of healthcare-acquired infections. I welcome and support this part of the Bill as well. Again, I declare an interest. I am chairman of the National Patient Safety Agency, an organisation that has done a considerable amount, particularly with its "clean your hands" campaign, to help to reduce healthcare-related infections, as the Minister is aware.
	I have some questions about the scope of the code of practice, which others have mentioned. The code is not available to us now, but it would have been better to have had it to enable us to comment on it when debating the Bill. I hope that the Minister will comment on that and that we will have the opportunity in Committee to probe further on the scope of the code of practice on healthcare-acquired infections.
	I also have concerns about the definition of healthcare-associated infections. The definition in the Bill refers to any infection which an individual "may be" exposed to. The definition used by the Health Protection Agency is much better and does not include the words "may be". Again, we will have an opportunity to explore this further in Committee.
	I support Clause 15 on the functions of the Healthcare Commission in relation to the code of practice, as the body which ensures compliance with the code. There are, however, issues to be discussed with regard to improvement notices—for example, the length of the specified period which an organisation must meet to comply with the notice, the redress open to the Secretary of State if the organisation does not comply, and so on. What are the likely effects of the code of practice on the training of health professionals, and will it require more resources to implement them?
	Part 3 of the Bill refers to drugs, medicines and pharmacies. This part of the Bill is in response to the fourth report of the Shipman inquiry and relates to the safe management and audit of controlled drugs. It is right that an accountable officer should be responsible for ensuring the safe use of controlled drugs and for best-practice guidance on the handling of controlled drugs. We have examples reported to us by the National Patient Safety Agency in relation to the harmful effect of some controlled drugs, which will soon be out as an alert to the service.
	As I said in the beginning, I welcome the Bill. Apart from some areas requiring further clarification, I shall support it. In bringing in Part 1, which relates to smoke-free premises, the Government have made a greater contribution to public health and health gain than any government in decades.

Lord Rosser: My Lords, I wish to speak in support of the Bill as it has emerged from its passage through the other place. In particular I wish to talk about two aspects: namely, the provisions to make enclosed public places and workplaces smoke free; and the clauses related to the Appointments Commission. I welcome the smoke-free provisions; they are health and safety measures. They do not represent a ban on smoking as some have sought to suggest. What the provisions do represent is the freedom for people not to be forced to inhale potentially lethal second-hand smoke in enclosed public places or in their place of work.
	Inevitably the measure has been opposed as an attack on the liberty of the individual to, in this case, smoke. The requirement to wear a seat belt was also opposed on the same grounds, but I do not think there are too many people now campaigning against that measure, which was also a health and safety one. Others—namely, many representatives of the tobacco industry—continue to deny the overwhelming evidence of the adverse effects of second-hand smoke, just as for many years the industry maintained that smoking itself was not a cause of concern, even though it has now emerged that it had known about the consequences of direct smoking for some years. If there is anyone who believes that all captains of industry are beacons of integrity and honesty they should take a close look at the tobacco industry in that regard.
	Second-hand smoke does kill. The Scientific Committee on Tobacco and Health, which advises the Government, has said that exposure to second-hand smoke increases the risk of lung cancer and heart disease to non-smokers by about a quarter. That exposure in the workplace has led to some 600 deaths a year; or three times the number killed in industrial accidents. It also causes illness and not least asthma attacks at work. It is precisely because this is a health and safety issue at the workplace that it was not acceptable, as originally proposed, to exempt membership clubs and pubs not serving food, neither of which could be regarded as having any similarity to places of residence.
	In the Irish Republic, where similar measures to those in the Bill have been introduced, one person in three used to smoke; this has now fallen to one person in four, which suggests that the measures will have a favourable impact on levels of smoking. Government figures suggest that the measures contained in the Bill will lead to hundreds of thousands of people in England giving up smoking to the benefit of their own health, differences in life expectancy between social classes and the National Health Service.
	Neither are the measures in the Bill likely to have an adverse economic effect. Bar sales in Ireland rose by more than 5 per cent in the year to October 2005 and I understand there was a similar trend in the year following the introduction of New York's smoke-free air act. The case for these measures in the Bill is overwhelming, and once they have been brought in I am sure they will quickly be accepted as the norm and not subsequently be reversed.
	I also wish to talk about the measures in the Bill relating to the Appointments Commission. Under Clause 57 the Secretary of State will be able to direct the Appointments Commission to exercise all or part of her power to appoint, among others, non-executive members of strategic health authorities, primary care trusts, NHS trusts and special health authorities. I am sure that the Secretary of State believes that non-executive members have a vital role to play, and are not there just to be seen but not heard in order to give the necessary veneer of respectability to governance arrangements. If I am correct about the Secretary of State's view, and I have every reason to believe that I am, it will be necessary to make sure that her view about the importance of non-executives and the need to support them in their role is reflected in the culture of her department and throughout the health service.
	The reason for my raising this issue is an example which has been brought to my attention, and over which my noble friend Lord Warner has been extremely helpful, of non-executives being treated effectively as peripheral figures in a health service organisation. That organisation is one of those that now have problems with their finances.
	We will neither attract nor, equally significantly, retain the calibre of person we want as non-executive members if they are left with the feeling that they are wasting the time they are prepared to give, in what are already full and busy lives, because they are either being thwarted in carrying our their role through being ignored or have repeatedly to fight and press to have any sort of meaningful involvement. People of ability who have something of real value to contribute will not accept that kind of treatment. Either they will not apply or, if they are already in post, they are liable to walk away.
	Perhaps the case that I have had drawn to my attention is the one exception to the rule. If my noble friend can assure me that it is, I will of course accept his word. However, if, like me, he has a feeling that this is not the case, I hope that he will make sure that the general issue of the level of involvement in practice, rather than in theory, of non-executives, and their role in the effective running of the National Health Service, is pursued. Otherwise, the appointments commission referred to in this Bill will be wasting much of its time in making such appointments.

Lord Naseby: My Lords, I have no interest to declare in this Bill and I certainly have never smoked in my life. It is clearly an important Bill and one should assess it in the total context of health policy, cost, and priority of health need.
	The National Health Service is probably at an all-time low in terms of its management. We are told that it is running at a loss of £750 million a year, which is still rising. I note that the Minister in introducing the Bill did not, to the best of my knowledge, tell noble Lords the costs of each part of the Bill. When he winds up, I hope that he will be in a position to tell us the cost of implementing each of the varying parts of this important Bill.
	This is clearly a very strong anti-smoking Bill, but it is very much in contrast to the Government's health policy overall. I mention, first, alcohol policy. Though too much alcohol is detrimental to health, the Government have extended drinking hours and made alcohol easier to obtain. Secondly, we see a continual easing of the policy on the taking, using and obtaining of drugs, be it cannabis or the new dance drug. Thirdly, I mention gambling. Gambling is very much a social ill, yet we see in the Government's policy a provision to increase the opportunities for families to gamble. Most of us, who have either served in the other place or seen a bit of life, know what a tragedy and a disease gambling can be, and how terrible can be its consequences.
	Fourthly, a report placed in all our boxes today points out that the Government's obesity policy at present is in complete tatters. It is an obesity policy which should be implemented properly and one which has come to the fore particularly in the past seven to 10 years.
	That is the background. I now consider the science. Perhaps I may say to the noble Lord, Lord Patel, that I do not have my head in the sand. He is a scientist; I am not. During my national service, I learnt to fly in the Royal Air Force. The science of aviation used to be crystal clear in relation to sonic travel: everyone said that it was fundamental and definite. That was changed dramatically when they discovered the real effect of going through the sonic barrier. Noble Lords will remember the problems of Concorde and others. Science changes with further information. I do not say that it will change necessarily in relation to smoking. The evidence is quite clear and fundamental about the person who smokes. But I have yet to be convinced about passive smoking. I may be wrong, but others have been wrong—not least in the example I have given. To get a little nearer to the world about which the Minister knows, the same comment would apply to vitamins and minerals. Twenty years ago the medical world scoffed at the role of vitamins and minerals. Today that has all changed and most people—the Government included—recognise that there is some role for some vitamins and some minerals.
	In considering the 1998 and 2004 reports of the Scientific Committee on Tobacco and Health—SCOTH—noble Lords, myself included, and interested parties should have the right to see the evidence, debate and minutes of that organisation. With the greatest will in the world and seeking to be objective, that scientific committee appointed by the Government does not have the most balanced membership. It does not have that degree of balance for me as an individual to have total faith in it. However, I find it strange that at this point in time SCOTH has not allowed its minutes to be made fully available. They are not yet in the public domain. In addition, I am informed that the papers which have partially been provided have been redacted. Some would say another word for redacted is censored. That may be going a little far; I do not know. If the evidence on passive smoking is so clear—I have an open mind—why is that evidence not made available to interested parties? Perhaps the Minister will cover that point when winding up.
	I do not know why there was not proper debate in another place about ventilation and air conditioning. My noble friend Lady O'Cathain says that she is totally convinced; that that subject is irrelevant. But looking at the world of air conditioning, extraction and so on, is not irrelevant.

Baroness O'Cathain: My Lords, I thank my noble friend for giving way. I never once said that ventilation or air conditioning was irrelevant. I never used the word "irrelevant". In fact, a study showed that in Ireland it proved useless.

Lord Naseby: My Lords, my noble friend has now added to her speech and anticipated that she meant to say it and forgot to say it but now believes that what I am saying is totally irrelevant. Either way, it is not helpful and a little bit over the top, for the other place to totally ignore developments in this area. If we take it that some people want to smoke, cannot stop smoking or get enjoyment from smoking, and if ventilation is sufficiently improved so that the effect of passive smoking is negligible, that is particularly relevant. It is not acceptable in a society in which one-quarter of our population want to smoke—okay, it is a minority, but it is one-quarter—for those means that make it possible for them to do so to be totally pushed aside and ignored.
	I turn to the nature of the ban itself. I read the Labour manifesto, as I suppose that all those of us who are interested in politics read our opponents' manifestos—I even bought a copy; and I have noted what the Labour Party's policy was on smoking, because we have had debates in your Lordships' House on that subject, in which I have taken part. I noted the public consultation Choosing Health; indeed, I read it. That document came forward with some exemptions. There is only one that I want to focus on: the situation of genuine membership clubs, which are not commercial clubs but are controlled by the members, who set the policy of the club and have annual general meetings in which they can change the policy, if they do not like it. The Secretary of State, on the morning of the Second Reading in the other place, recommended that membership clubs should be exempt; by the evening she had changed her mind and voted in the opposite Lobby. I am not sure that too many members of the public can have much faith in a Secretary of State who is such a will o' the wisp.
	Licensed members' clubs, in relation to the debate in the other place, were simply rolled up. There was a sort of euphoria from the health people, who wanted to ban all smoking and anything to do with smoking—and out of the window went the licensed clubs. Nobody was worried about the liberties or freedoms of people in those clubs and what they wanted to do. Nobody recognised or remembered the genuine nature of those clubs; they were all totally ignored and swept into prohibition. The Government are totally ignoring what the public wants, which is a smoking policy that provides a choice of facilities for smokers and non-smokers alike; they seem to forget all about that and ride over the nature of those clubs.
	Those clubs hold a certificate, as noble Lords will know, and are run by and for the benefit of the members. They can decide, as members, what they do, at their annual general meetings. Even the Under-Secretary of State in another place said:
	"Private clubs are exempted on the basis that their members are adults who choose to sign up to the regulations of that club. They have a say in . . . whether smoking should be allowed at all or in certain areas. Many clubs already apply rules in that area, including no smoking in bars".—[Official Report, Commons Standing Committee E, 8/12/05; col. 87.]
	I shall table amendments in Committee to restore the right of membership clubs to choose whether they wish to ban smoking.
	In passing, rural pubs seem destined to be lost to us all. I shall not develop the point now, but I may do so in Committee.
	I listened to the Minister trot out statistics and forecasts and have heard other statistics bandied around in the Chamber. I think that the Minister said that the BMA quoted a figure of 30 people a day dying from smoking, but the age at which they were dying was left undefined. Naturally, everybody dies, so it is not a very meaningful statistic. We are told that thousands of lives will be saved, which is very emotive. Given that we are down to 25 per cent of people smoking, that figure seems to me a bit questionable and highly unlikely. Again, although I am sorry to come back to my noble friend Lady O'Cathain, I thought I heard her say—I shall hurriedly give way to her if I got it wrong—that 600,000 people would be saved from dying if we got rid of passive smoking.

Baroness O'Cathain: My Lords, I thank the noble Lord. I have a horrible feeling that I have also misquoted a figure, which another noble Lord also mentioned. The Minister referred to a figure of 600,000—I wonder if he could give me some help on that, because I was quoting him.

Lord Warner: My Lords, I think that the noble Baroness has subtly missed the comma in my concluding remarks. I actually said that 600,000 was the estimated number fewer smokers; there was then a comma after that, and I went on to say that there would be many lives saved. Noble Lords may have elided the "600,000" with the "many lives saved".

Lord Naseby: My Lords, those of us who were listening to the Minister heard him quite clearly, and I wrote that figure down. But then my noble friend extrapolates that—like so many others in this debate. I can see the headlines tomorrow.

A noble Lord: No!

Lord Naseby: No, says the noble Lord, but he does not know the press and he certainly does not know the health lobby. But at least we have now established that it is not 600,000 people dying from passive smoking, although the noble Baroness clearly thought it was, otherwise she would not have said it—or perhaps she was not listening properly and she wished it was. But, either way, let us move on.
	I am not sure whether the Minister was totally clear on the saving to the NHS. I am not sure whether he said £100 million or £100,000 million, but perhaps he could clarify that in his winding-up speech, as he has already given the figure. If he would be kind enough to say what the savings to the NHS actually are, we would take that at face value, and it would help the debate.
	I conclude by saying that as someone who has taken an interest in this subject, I will listen to objective science, but I am not willing to listen to science with a twist on it. Noble Lords who are scientific need to recognise that science is not always totally accurate—and I have given two examples. If government policy is taken to its logical point, the Government should be banning smoking—but they know that they cannot do that because 25 per cent of people want to smoke. Furthermore, what possible trust can people have in the Government when they state one thing in their manifesto and then go and do almost the opposite in reality?

Baroness Murphy: My Lords, noble Lords may be relieved to know that I am not going to talk much at all about the smoking business. My views, both as a doctor and a chairman of a strategic health authority are so predictable that you could almost take them as read. I congratulate the Secretary of State, Patricia Hewitt, on finally voting against her own department's original proposals—although I was sad to see that one health Minister did not support the healthiest option of smoke-free public premises. I hope that that particular Minister will not be around monitoring the performance of my authority on our smoking cessation targets.
	I add my voice to the voices of the noble Baronesses, Lady Rendell and Lady O'Cathain, who raised the issue of providing better protection for residents of care homes and nursing homes, who often have to suffer the smoking of other residents and staff. I have regularly witnessed that in registered care homes and nursing homes, and we must find some better way in which to protect those individuals.
	As the noble Lord, Lord Patel, said, this is probably the most important public health measure proposed in the past few decades, and I strongly support the Government's current proposals.
	I turn to the new pharmacy regulations, and hope that the Minister will be able to put my mind at rest on a few points. First, I want to say how much I welcome the new pharmacy strategy and the new proposed wider role for community pharmacies in primary healthcare, and to support the increased contribution that they can make to public health and possible practice. We have 37,000 pharmacists in the UK; highly trained, skilled professionals whose talents are often underutilised under the current arrangements.
	Those noble Lords who have visited Italy, France and many other European countries will know that the local pharmacist often plays a key primary care role, and is expected to give advice and guidance on a wide range of healthcare matters relating to medicines and products and on public health issues. It is enormously beneficial and easy to be able to consult a high street pharmacist on the spot, and to widen access to pharmacy services must be a good thing.
	On the face of it, the current proposals make a good deal of sense. There will cease to be an obligation for a pharmacist to be physically present at a pharmacy while medicines are being dispensed. There will be a designated responsible pharmacist in overall supervision, but not required to be present at all times. The supervision of the pharmacy may be by remote mechanisms, by robotics, video links, electronic means of viewing prescriptions and so on. But it seems to me—and this has been raised by the Pharmacists' Defence Association too—that the provisions, if not properly implemented, may have the unintended consequence of lessening the public's access to a community pharmacist in more deprived areas and provide fewer safeguards for patients in terms of supervision of their medications.
	The primary role of the pharmacist is to ensure the safe sale and supply of medicines in the pharmacy, and he or she is uniquely qualified to do that. The PDA deals with the many dispensing errors and near-misses, and knows, even though now 80 per cent of medicines are pre-packed and bar-coded, that drug errors still occur, and that technicians and dispensing assistants are not equipped to cope with an unexpected incident where an intervention may have to be made quickly to avoid harming a patient. The prolonged absence of a pharmacist will undoubtedly leave many decisions to assistants and technicians.
	It looks as if it could be possible under these proposals for a pharmacist to supervise more than one pharmacy at once, by being officially in one pharmacy and providing cover remotely as a supervisor at another. I fear that companies with several pharmacies will simply reduce the number of qualified pharmacists they employ in some areas. The commercial reality of the pharmacy industry in inner-city areas, and in some remote rural areas where there are already recruitment problems and great difficulty in finding locums, could lead to the creation of a two-tier system of well staffed and poorly staffed pharmacies.
	I do not want to downplay the skills of our valuable registered pharmaceutical technicians, nor our dispensing assistants, but the fact is that they are at their most useful when they work directly with, and are learning from, an expert pharmacist in a close-knit multi-disciplinary team. How many hours will a pharmacist have to spend in the pharmacy per day or week or month in order to be designated as a responsible pharmacist? Has that been considered with regard to patient safety? Will the Minister explain how regulations can be, as it says in the Government's Health Bill information paper, tightly drawn to ensure that the absence of a pharmacist will be permitted only in specific and defined exceptional circumstances, yet designed to ensure the responsible pharmacist has sufficient time and flexibility to offer other services away from the pharmacy? How can a pharmacist supervise a remote pharmacy over extended periods without compromising safety? How long might he be away for?
	What about pharmacies that open 100 hours a week or more to satisfy the exemption from control of entry regulations to NHS prescribing status? Can we be reassured that there will be one responsible pharmacist for every community pharmacy? Will the Minister clarify under what circumstances a responsible pharmacist could supervise more than one pharmacy? Finally, what is the remote pharmacist permitted to do when he or she is away from the pharmacy? I hope, because this is one of my fears, that it will be providing healthcare rather than simply driving around town between his six other pharmacies.

Viscount Simon: My Lords, I think it was last week that an article was published in what we used to call a broadsheet about climate change and global warming, which was followed by an assessment by a television presenter who drives fast cars. He said that while there was still one expert who says climate change is not taking place, he would not believe it. I would love to know whether this gentleman has found an expert who says that smoking does you good.
	I have to declare an interest. My hospital records show that I have severe acute allergic brittle asthma. What does this mean? I can become very ill indeed—at worst, within 20 seconds—following inhalation of one or more of numerous chemicals. What has this to do with the Health Bill? There are many chemicals that lead me to being ill that cannot be quantified, nor indeed controlled, but I can become ill with one inhalation of certain types of tobacco smoke, with that from cigars being the worst. I am not alone in that respect.
	The noble Lord, Lord Naseby, talked about passive smoking. I will give him two examples. First, the noble Lord, Lord Brougham and Vaux, had to relieve me a couple of weeks ago when I became ill while chairing the Grand Committee because tobacco smoke came up a ventilation shaft. Secondly, I will have an asthma attack if I am driving up a motorway with my windows closed and someone else is smoking a cigar. It will not be a bad attack, but I will have to take some medication.
	All those who smoke have a perfect right to do so, but there are many people like me who should have the right to inhale smoke-free air. Exposure to second-hand smoke is the second most common asthma trigger in the workplace, and working where others smoke doubles your risk of developing asthma. Indeed, there are many non-smokers without any illness who would like to breathe clean air—like me. That includes employees in the hospitality industry, where one person so employed dies every week. To make matters worse, the BMA published research last year that showed second-hand smoke is likely to be responsible for the deaths of more than two employed people for each working day of the year. Everyone has a human right to work without being exposed to poisonous and life-threatening substances, and many people, including those with asthma, are currently excluded from many social environments because of the damaging effects of second-hand smoke.
	Comprehensive legislation benefits health. Smoke-free laws prevent ill health and second-hand smoke, and encourage smokers to quit, as has happened in Ireland. They motivate smokers to protect their families from second-hand smoke in the home.
	What would this country be doing if Sir Walter Raleigh had introduced cannabis, not tobacco, into this country all those years ago? Probably not very much. But, in general terms, cannabis does not affect other people, but tobacco does, and its smoke should be rigorously controlled. I welcome this Bill.

Lord Geddes: My Lords, I have enormous sympathy with the noble Viscount, Lord Simon. He put his finger on the point: those who do not wish to smoke should not suffer from second-hand smoke, but those who wish to smoke should be allowed to. That is the essence of what we are talking about. I declare an interest as a proud member of the Lords and Commons Pipe and Cigar Smokers' Club, although I smoke neither pipes nor cigars.
	Like my noble friend Lord Naseby, I wish to concentrate on Part 1 of the Bill, particularly Clause 3, which deals with private membership clubs. Clause 3 gives the illustrative example of homes and places of permanent or temporary living accommodation, including hotels, care homes—as the noble Baroness, Lady Rendell, mentioned—and prisons, as places that may be exempted by regulation. As an aside, I can see a farcical situation developing in prisons, where the prisoners concerned can smoke, as they are exempted. But what about the prison warders? That is their place of work. Are they allowed to smoke? Perhaps the Minister could clarify that.
	Clause 3 continues specifically to prohibit the exemption of premises having a premises licence or club premises certificate under the Licensing Act 2003, which includes of course pubs, bars and private membership clubs. There is a special case for genuine private membership clubs. The licensing regime recognises that genuine membership clubs are significantly different from licensed premises. There is a technicality on the two different types of licensing, but I will not bore your Lordships or take up their time on that one. As my noble friend Lord Naseby rightly said, clubs holding a club premises certificate—that is the difference between a normal licensing certificate and one that affects clubs—are run by their members, who choose freely to associate with each other. They are run principally for the benefit of their members, and under their rules there is accountability to the members of the club who determine how the club is managed and operated. Surely a private institution like that can make up its own mind. No one is obliging anybody to become a member of such a club, but if you are a member of a club why can't you indulge in smoking if you so wish?
	I have done quite a lot of trawling of press reports. I do not normally rely that much on what the gentlemen of the press say, so I have tried to give as wide a spectrum on this as I could. I shall quote extracts in no particular order. There was an interesting comment on 19 February from the noble Lord, Lord Rees-Mogg, in the Mail on Sunday:
	"MPs think they have the right to stop us smoking, if we wish to do so, on private premises in the company of friends . . . It is an invasion of private freedom; it is an abuse of power of Parliament, none the better for being carried on a free vote of the House of Commons. They use their free vote to take away our personal freedom".
	I then found one in the Yorkshire Post—not exactly the same as the Mail on Sunday—of 15 February:
	"The smoking ban agreed last night is an illiberal piece of legislation that severely restricts freedoms of choice and the rights of publicans and club owners to run their businesses as they see fit".
	Then from the Sun—normally a periodical or newspaper that I would have thought supported the present Government:
	"We always knew New Labour were a bunch of control freaks. Now, with this ludicrous and unnecessary smoking ban, they stand as out-and-out fascists".
	Switching slightly now, in political terms, to the Times—or maybe not switching; I do not know which way the Times leans nowadays—of 16 February:
	"The pettiness of this official persecution of smokers (who are not prevented from paying a lot of tax) can hardly be exaggerated".
	My final quote is from the Daily Mirror, again not known to be a supporter of this side of the House, whose correspondent said:
	"What riles me is that as part of this government's manifesto, the deal was a partial ban. They lied. Secondly, we, the British public, have laid down, rolled over and allowed our liberty to be taken away".
	I would now like to concentrate on that last point: the manifesto. Again, my noble friend Lord Naseby has done a great service in bringing that to the fore. Let me just quote the relevant sentence in the Labour Party manifesto and then elaborate slightly on that. The manifesto said:
	"In membership clubs the members will be free to choose whether to allow smoking or to be smoke-free".
	The Government have been increasingly praying in aid their election manifesto. As recently as two days ago the noble Baroness, Lady Amos, the Leader of the House, in a slightly testy 10 minutes just after Question Time, prayed in aid with relevance to the reform of this House. That is not the point, but the subject matter is. The point that I submit is that she said:
	"My Lords, government policy on House of Lords reform was set out in a manifesto on which this Government won an election last year".
	In the space of 10 minutes, she used that argument three times. The last of them, chronologically, was:
	"The Government's policy on House of Lords reform remains as set out in our manifesto last year".—[Official Report, Lords, 27/2/06; cols. 11-13.]
	The Government cannot have it both ways. I suggest that there is a certain amount of cherry-picking going on here. When it suits, the manifesto is called in aid; when it does not suit, it seems to be torn up. Other noble Lords may have got the letter that I received this morning. It is on the subject of ID cards, which indeed is coming back to your Lordships' House next Monday, if I remember correctly. It is nothing to do with this Bill at all, but with the point of the manifesto:
	"I believe that Tony Blair and his Government, by stating in their manifesto that ID cards would be voluntary, have created a sense of apathy among the general public, myself included".
	I repeat: either the manifesto is adhered to or it is not, and it was made very clear in the Government's manifesto in May last year that private clubs would be exempted. I certainly will be supporting my noble friend Lord Naseby, if he sees fit to put down an amendment on that subject.
	Just one final comment: it is a personal one and to me rather surprising. My wife is vehemently anti-smoking. She hates my smoking and tells me so on numerous occasions. But when the ban on private clubs was passed in another place some 10 days ago, she went incandescent with rage and said, "How dare they invade the right of private individuals to do what they want on their own premises?" I give that as one illustration and I do not believe that it will be unique.

Lord Skidelsky: My Lords, I will confine my remarks to Chapter 1 of Part 1 of the Bill, which legislates to ban smoking from public buildings and workplaces. This of course was not the Government's original intention but, since the Cabinet was divided, the matter was left to a free vote of the Commons.
	My opposition to Chapter 1 of the Bill is based on a single point. It is grossly disproportionate and off target relative to the harm, such as it is, caused by passive smoking. I thought that I would be in a minority of one after listening to the debate, but as it is I am glad to follow the powerful interventions of the noble Lords, Lord Naseby and Lord Geddes. If there is a rational basis to the Bill, it seems to be this: the Government are determined to stamp out smoking or at least heavily reduce it from its present level of 25 per cent of the adult population. I am told that the Department of Health has a target for reducing smoking to 21 per cent by 2010. I do not know whether that is true, but it seems plausible. Since banning smoking outright would seem to be too gross an interference with liberty—there are still too many smokers around—the idea is to reduce it by claiming that it harms others. If there are fewer places in which people are allowed to smoke, it seems to follow that fewer cigarettes will be smoked. That seems to be the rational basis for this Bill.
	What is wrong with that basis? If the attack on passive smoking helps to rid society of tobacco, is that not a good aim? The answer is that it is corrupt. The quality of information that the public receive is vital to the proper functioning of a democracy. I fear that we have got into the absolutely appalling state where it is widely accepted that the end justifies the means. We saw it with Iraq: it did not matter whether Saddam Hussein had weapons of mass destruction, we got rid of him, and wasn't that a good thing? The same attitude seems to be prevailing here. It does not matter whether passive smoking actually does do that much damage provided that the end result is a reduction in smoking.
	There is also the not insignificant matter of the assault on freedom. An office with two persons is designated a smoke-free zone even if both occupants want to smoke. A group of smokers will not be able to form a private club. As far as I can make out, even private dwellings and private motor cars may at some time in the future be designated smoke-free zones on the order of the Secretary of State. So this Bill is not the end of a process; it is part of a process which may result in a much greater interference with liberty than is at present contemplated, grave though that is.
	I refer noble Lords to the Explanatory Notes on Part 1 of the Bill, which state:
	"The Bill will also give the Secretary of State for Health the power to make regulations specifying places or specified areas within them that do not have to be smoke-free. These will include premises where a person has his home".
	The Englishman's home will for the time being remain his castle by permission of the Secretary of State.
	I do not deny for a moment that smoking is dangerous to one's health. How could one? Some 100,000 people a year are said to die of smoking-related diseases, 30,000 of them from lung cancer. But even here we must be careful. What does it mean to say that smoking kills? Everyone dies. What the statement must mean is that it causes premature death. What the statement that 100,000 people a year die from smoking-related diseases actually means is that 100,000 smokers die on average somewhat earlier—up to five year earlier, it is said—than non-smokers.
	The question then is: how dangerous is passive smoking? Before trying to answer that, I have a health warning of my own. The interpretation of smoking statistics is fiendishly difficult. That is why they tend to give way in legislative assemblies to anecdote or general statements. And I do not blame politicians for not understanding statistics; very few people understand statistics. What I blame them for is being too careless of liberty.
	So the question is: how dangerous is passive smoking? There have been more than 50 studies of passive smoking over 25 years. The firmest conclusion is that non-smokers exposed to environmental tobacco smoke at work and at home show an increased risk of lung cancer of about 20 per cent—it may be a bit more or a bit less. How many extra premature deaths is that? If we assume a 20 per cent risk, the answer is about 650 extra deaths a year.
	Earlier this year, the House of Commons Select Committee on Health said:
	"It is currently estimated that SHS"—
	inhalation of second-hand smoke—
	"causes at least 12,000 deaths each year in the United Kingdom".
	That is deaths from all smoking-related diseases, not just cancer. However, I have to emphasise that 12,000 is not a robust figure. The US Environmental Protection Agency estimates that there are 3,000 environmental tobacco smoke-related deaths in the United States, which has five times the population of the United Kingdom. Even in Britain the estimates range from several hundred to 12,000.
	If you assume that passive smoking causes a 20 per cent increase in the risk of lung cancer and that there are as many deaths from other causes relating to passive smoking as from lung cancer, which is not unreasonable, the rough estimate of premature extra deaths on the basis of available data is about 1,300 a year. That is roughly consistent with the British Medical Association's estimate, which is 1,000. So that is the sort of order of magnitude of the premature deaths caused by passive inhalation of tobacco smoke.
	Another approach to the question—a more intriguing one, I think—would be to ask by how much life is shortened by exposure to environmental tobacco smoke. Obviously it is less than by the five years' shortening suffered by the active smokers. The US Center for Environmental Health has estimated that the mean cotinine level of non-smokers exposed to ETS—that is, the level of toxic substances in tobacco smoke—is 1/500th that of active smokers. If we assume that the increased risk of premature deaths from environmental tobacco smoke relative to smokers is reduced in proportion, then 1/500th of five years works out at about four days. So whether the number of premature deaths caused by passive smoking is 12,000 or 100,000 or 1,000, if we assume that on average smoking reduces life expectancy by five years, then passive smoking reduces average life expectancy by four days per person.
	As the House of Commons Select Committee recognises, most deaths from passive smoking are caused by domestic exposure to second-hand smoke; that is, living with a smoker. Various studies, including one by Professor Konrad Jamrozik of Imperial College London, imply that only about 15 per cent of deaths from passive smoking are caused by exposure to environmental tobacco smoke in public places—the places which the Bill proposes to make smoke-free zones. Thus we are talking about between 150 and 200 premature deaths a year from passive smoking. That means that the maximum decrease in average life expectancy from exposure to ETS in public places is about 15 hours per person. Now, I am just trying to lead you on to what statistical manipulations can achieve if you want to follow the logic of these matters. And, after all, we should not entirely dispense with logic in framing our legislation.
	These numbers are impossible to prove statistically. This is because the increased risk from passive smoking is too small to determine given the quality of the data. To say that passive smoking would lead to an increase in the incidence of lung cancer from 10 per 100,000 non-smokers to 12 per 100,000 is statistically meaningless. The cautious experts refuse to commit themselves to a number.
	"I think that passive smoking has to be causing some risk",
	one expert recently told the House of Lords Select Committee on Economic Affairs, of which I am a member, but he refused to name a number when pressed several times. He said that it must have some effect.
	So what conclusion does one draw? The part of the Bill dealing with passive smoking seems to me to be based on a false prospectus. It relies on a manipulation or lack of understanding of the statistics. At best, it is using a sledgehammer to crack a nut and it is grossly careless of liberty. It does not deal with the main risks from passive smoking, which arise from the home, and whose biggest, non-lethal impact is on young children. Indeed, the smallness of the risk of dying from passive smoking has caused the argument to shift to the non-lethal damage done by passive smoking rather than the lethal damage.
	I am deeply sympathetic with the plight that the noble Viscount, Lord Simon, movingly described in his speech. I would simply say that the legislative response must be proportional to the damage. Not only do we have very little data on non-lethal effects, but the response must be much more nuanced than it is in the Bill.
	If the Government honestly want to reduce smoking, they have two legitimate weapons—education and taxes. Both have already had a big effect, not a negligible effect. Only a minority of adults now smoke. Pressure from the majority of non-smokers has led to most working places and many hotels and restaurants becoming non-smoking zones. Public opinion is already achieving what the Government aim to do by legislation, without trampling on the liberty of smokers to choose where they want to work and relax. I am saying this as an ex-smoker.
	If governments want to accelerate that movement, there is no reason why they should not continue to raise taxes on tobacco to the point at which smoking becomes the vice of the rich rather than the habit of the many. It will be claimed that that approach would disproportionately hurt the poorer sections of the population who smoke more. But those groups will also gain disproportionately from the improvement in their health. Rather than using the price mechanism, or "sin taxes", which is the natural thing to do if you want to reduce the quantity demanded, the Government prefer that all smokers should suffer an equal loss of liberty. Equality of deprivation has always been more attractive to some people than freedom of choice.
	We are faced with a demand to legislate which, although I believe it to be unnecessary, is almost certainly unstoppable. Therefore, I will be looking to introduce or support amendments in Committee that exempt private clubs from this legislation, and in other ways to modify the blanket prohibition of smoking in public places.

Baroness Howarth of Breckland: My Lords, although I have an interest in several areas of the Bill, I intend to concentrate at Second Reading on smoke-free public places. I am still trying to work out which of the gods placed me after the noble Lords, Lord Skidelsky and Lord Geddes. In no way will I try to tackle the statistical analysis, although there were moments when I thought that the noble Lord made my point for me. I am grateful that he made more suggestions about how we can reduce smoking.
	This House has already demonstrated that it puts the health of the community first by voting for the London and Liverpool Bills, which await the outcome of this legislation. Noble Lords also voted for smoke-free areas in virtually all parts of this House, showing that they care for their own staff—that is the issue about private clubs—as well as their own health. I had the privilege of taking a leading part on both those Bills and now speak in support of this Bill, so that the legislation can be enacted at the earliest opportunity in 2007 to ensure that all workers have the same level of protection. Although the noble Baroness, Lady O'Cathain, is not in her place, I would join her in trying to ensure that the whole of the Palace becomes smoke-free.
	The BMA has written expressing its delight that Members of the other place opted to put the lives and health of their constituents first and vote for a total ban. Although there were moments when the leadership on the issue looked a little shaky, we were all delighted when the ban went through. That showed that we have a listening Government that can look at the facts and change their mind. Whatever is in the manifesto, I thought that listening meant that you were capable of changing your mind during the course of a Parliament. For that I am grateful—after all, you may change your mind about other things, too.
	A partial ban on smoking in public places would have brought nothing but unworkable chaos and the most disadvantaged in our society would have continued to be at the greatest risk. Therefore, I hope that Members of this House will not try to introduce amendments to raise sectional interests—although I understand now that they will. I have no sympathy for the arguments on behalf of private clubs. I have talked to workers who work in private places. Of course they say, "Yes, I think it's alright", until you ask them privately. They say it is alright because they know that they will lose their jobs if they say that it is not alright. I have examples.
	It would be inappropriate for me to repeat the vast array of evidence that we outlined in the London and Liverpool Bills, but some facts bear repeating. The research published by the British Medical Journal last year—and I hope that these are the right statistics—showed that second-hand smoke at work is likely to be responsible for the deaths of more than two employed people in the United Kingdom every working day. That is 617 deaths a year. If you start to divide that up into tiny proportions of hours and days it may seem small compared with the whole population. But I thought that in areas such as this we worked on the precautionary principle—that we care about our community. It is, I hope, the same attitude that we took in relation to BSE and vCJD. Certainly, there are not thousands of people dying from vCJD, but I hope that we continue the precautionary principle to ensure that people do not die that terrible death any more than the terrible deaths I have seen from diseases such as cancer that have resulted from smoking and, I believe, secondary smoking.
	Professor Vivienne Nathan, director of professional activities at the BMA, wrote me a telling letter. She stated:
	"The health evidence that second hand smoke kills is beyond dispute"—
	that is the view of the BMA—
	"but doctors' knowledge does not just come from scientific papers—we see the evidence in the lives of our patients and their families. We see that the least affluent patients bear the heaviest burden of the disease from smoking and second hand smoke, and know that this suffering is preventable".
	I know that the positive effect on bar sales has already been mentioned, and maybe some of us have views about alcohol in relation to that, but it shows that business has not been particularly affected by a ban. What about compliance? In the debate on the London Bill, noble Lords said that no one would do anything about it. People will not comply, they said.
	However, in March 2005, a report, Smoke-Free Workplaces in Ireland, A One-Year Review, contained the following key findings. Compliance with the smoke-free workplace legislation was very high—94 per cent of all workplaces inspected under the National Tobacco Control Inspection Programme were smoke-free; 92 per cent of all workplaces inspected by the Health and Safety Authority were smoke-free; 93 per cent of all hospitality workplaces were smoke-free. There is in Ireland overwhelming support for the law, with 98 per cent of people believing that workplaces are healthier and 96 per cent of people considering that the smoke-free law is a success. In addition, air quality in pubs has improved dramatically and more people like to go to them.
	I know that the issue of ventilation has been raised and I was not going to speak about that, as I talked about it in the debate on the London Bill. However, I have to tell the noble Lord, Lord Naseby, that an atmospheric physicist, James Repace, looked at the need for ventilation in smoke-filled rooms and what recycling that smoke would require. He said that it would take an air recycling rate of tornado-like force to remove all the effects of secondary smoking. I thought that it might be worth the expense of watching some people try to light up in that situation. But that is what the physicist said—and we are talking about physics, not chemistry, anyway.

Lord Naseby: My Lords, I am grateful to the noble Baroness for giving way. I said that it would remove, not all, but the majority of, the problem. The majority, given the speech of the noble Lord, Lord Skidelsky, would indicate that the incidence would drop dramatically. Also, will the noble Baroness comment on why tobacco consumption is back on the increase in Ireland?

Baroness Howarth of Breckland: My Lords, I do not have the facts on that, but I am prepared to look at them and come back to the noble Lord. However, I will probably leave it for the Minister to answer, as I have learnt from the noble Baroness, Lady O'Cathain, that that is the best approach.
	There is another positive aspect to this legislation. Critics have pointed out that the main smoking problem may be in the home. Maybe this is what the noble Lord, Lord Naseby, is relating. Clearly we cannot legislate at the moment for that, however much we hope to do so. However, passive smoking is a danger to vulnerable adults and to children, especially children with health problems. As patron and trustee of Little Hearts Matter, a charity which works with families of children with single-ventricle heart problems, I am particularly aware of this. There is a myth that this Bill would increase smoking at home, but in fact the opposite would be likely, as it encourages smokers to quit. I understood that cigarette sales in Ireland had, in fact, fallen by 16 per cent. But again I look to the Minister for verification of that fact. Moreover, such a law increases public understanding of the risks of second-hand smoke. It raises a debate and therefore discourages smoking around children. Finally, it helps to prevent seeing smoking as a normal, even desirable, adult activity. I am so glad that so many of your Lordships have given up—maybe that is a good example, too. It is a real incentive to prevent young people smoking, which is a major problem in society. That is why I welcome the Government's plans to consult on raising the age for sales of tobacco to young people to 18.
	We also need to look at the problem of glamorising smoking. Television and theatre glamorise smoking and, when I mentioned it before, the noble Baroness, Lady McIntosh, accused me of not getting out enough. On reflection, and with my workload, I thought she might be right. But there is a real issue about how smoking is portrayed, particularly to the young.
	Other noble Lords raised the issue of smoking in residential homes, secure units, prisons and other long-stay settings. The problem might have been addressed had the London and Liverpool Bills gone to Committee. The Joint Committee on Human Rights has argued that smoking should not be completely banned from such establishments where people live "akin to their own abode". But where staff provide care, or where domiciliary workers visit people who smoke in their homes, much more thought is needed about the balance of protection and service delivery. What consideration is being given to the issue? The ALG and SmokeFree London encourage a blanket ban and I have heard that some unions have concerns for staff. I declare an interest as president and trustee of John Grooms, a charity providing residential care for severely disabled adults. I know that the sector is looking for a framework in which this clash of interests can be addressed.
	Perhaps I may mention three colleagues whose voices would have been heard could they have been here today. My noble friend Lady Finlay of Llandaff, president of Ash in Wales, asked that I remind noble Lords of the work she has done in introducing the Smoking in Public Places (Wales) Bill. She would have wished to contribute from her wealth of knowledge of the issue had it not been St David's Day—she is required to be in the land of the Bards. She would have spoken from her knowledge and about the increased risk of developing lung cancer and heart disease in those exposed to secondary smoke. Another supporter would have been Lord Stratford, Tony Banks, who made his maiden speech on this issue, and whose loss continues to be felt in this House. And, of course, my colleague Lord Chan, who spoke in favour of the London Bill. I think both would have raised their voices in this debate.
	The other place has set us a good example by a massive majority. It is time for England to come into line with Scotland, Wales and Northern Ireland, in protecting our workforce. Many bitterly resent the potentially fatal damage to their health from working in a smoke-filled environment. This is an opportunity for legislation to do real good. I hope your Lordships will give it the measure of support it so richly deserves.

Lord Monson: My Lords, I declare my usual wholly non-financial interest as president of the Society for Individual Freedom and a supporter of FOREST, although, of course, neither of those offices affects what I am going to say in any way. The fact that I am also a light smoker may do so to some extent—although I would hope that, even if I were not a smoker, I would stand up for individual freedom in the same way that the noble Lord, Lord Naseby, has, and the noble Lord, Lord Stoddart of Swindon, will do shortly.
	When this Bill received its First Reading in another place, I suppose it was correctly titled. It contained many inconsistencies and illogicalities, and was illiberal in many respects—but then illiberalism is par for the course where much recent government legislation is concerned. However, the legislation that has emerged from the Commons can be better described as a health fascism Bill and a slap in the face for the Labour manifesto on which this Government set such store. It embodies a puritanical zealotry we have not seen in this country for 350 years. As the noble Lord, Lord Rees-Mogg, wrote in the Mail on Sunday on 19 February, under the headline, "The week our freedom went up in smoke",
	"The House of Commons is full of busybodies . . . looking around eagerly for [any] . . . opportunity to bite into personal liberty . . . The ban on smoking in enclosed public spaces and workplaces . . . is an invasion of private freedom . . . [and] an abuse of the power of Parliament . . . They [MPs] use their free vote to take away our personal freedom".
	It is interesting to know how many of those who voted to shackle traditional English freedoms represent Scottish, Welsh or Northern Irish constituencies.
	We can all agree on one thing: when people's eyes, ears or nostrils are irritated by other people's habits, as so often happens, they normally have to suffer in silence through gritted teeth. So, if just one of those habits can be deemed not merely irritating but positively lethal to bystanders, it is only natural that the sufferers should take the opportunity to press for the habit in question to be heavily curtailed in their presence—however little truth there may be in the mortality claims. The operative words here are "in their presence". To a very large extent, this has already happened. For example, by 2004, smoking in the workplace for 92 per cent of the population was either banned or confined to segregated smoking rooms. Those who are especially sensitive to smoke, like the noble Baroness, Lady O'Cathain, will surely concede that life is very much more agreeable for people like her now than it was even five years ago, let alone 25 years ago.
	As the general public is much more tolerant than the current House of Commons, only 31 per cent of people want a complete ban in public places. Five per cent want no restrictions and a majority is entirely happy with separate smoking and non-smoking rooms in pubs and suchlike. According to the Office for National Statistics—and who could be more impartial?—this contradicts the claim made by the noble Baroness, Lady Cumberlege. But as the noble Lord, Lord Skidelsky, has already hinted, the long-term and indeed the medium-term, aim of the zealots is to turn all smoking into a shameful, outcast activity, indulged in furtively by men at street corners with their coat collars turned up as if they were peddling hard drugs or pornography. In other words, it is a form of psychological warfare directed against smokers. No matter that most of the men who fought in the trenches of Flanders in the first world war were smokers and honourable men. No matter that most of the men who fought in the second world war across the north African desert, up the spine of Italy, on the beaches of Normandy and in the jungles of Burma were smokers and honourable men, as were those who fought in the Battle of Britain. No matter that Winston Churchill, Clement Attlee and Harold Wilson all enjoyed their pipes or tobacco, as the case may be, and lived to the ages—note this carefully—of 90, 84 and 79 respectively. No doubt their pleasures will soon be literally airbrushed out of history, as Franklin Delano Roosevelt's perpetual cigarette holder has already been airbrushed out of history in the United States. Judging by what the noble Baroness, Lady Howarth, said, she would be quite happy if airbrushing took place in this country.
	The zealots hope to achieve their aim by claiming, which Professor Sir Richard Doll and Professor Sir Richard Peto never did, that second-hand smoke is so lethal that anyone entering a room, or indeed a company car, which the last smoker vacated possibly several hours previously is in mortal peril—indeed, the noble Baroness, Lady O'Cathain, claimed that 600,000 people a year die from passive smoking, but that figure is larger than the total number of people who die in Britain every year from all causes.
	If that were the case, virtually none of us would be here today. Anyone born before, let us say, 1955 necessarily, whether they liked it or not—and most of us did not like it—spent their formative years wreathed in other people's exhaled smoke, since, even if neither of their parents smoked, smoking in public places was ubiquitous. Yet our generation—or perhaps I should say "generations"—have statistically lived much longer than anyone predicted, much to the dismay of annuity providers. Incidentally, have any death certificates listed passive smoking as a cause of death? I think not.
	Anyone who doubts the draconian nature of even the original Bill should scrutinise Clause 11 and Schedule 2. By comparison, Clause 13 is relatively mild—albeit wholly inconsistent. It is inconsistent because five and a quarter years ago, on 13 November 2000, the noble Lord, Lord McColl of Dulwich—I am sorry that he is no longer in his place—revealed to the House that non-smoking teenagers who indulged in anal intercourse were twice as likely statistically to die prematurely as teenagers who smoked up to 20 cigarettes per day but took no similar sexual risks. Your Lordships, including many on the Labour Benches, took notice of what he said and voted accordingly. However, new Labour, against the wishes and instincts of old Labour but with Liberal Democrat support, forced that measure through by using the Parliament Act. How odd, then, that a minimum age of 18 is being set for the less dangerous practice while retaining a minimum age of 16 for the more dangerous one.
	One recognises that the Bill has not reached this House as the Government originally intended, but that is largely the Government's own fault, partly because some Ministers changed their mind at the last moment—indeed, some of them changed their mind several times in the course of a day—but partly because, as Terence Blacker pointed out in an excellent article in yesterday's Independent, which I commend to your Lordships,
	"government by anxiety has become a favoured New Labour method of dealing with its more intractable problems. At the first sign of sustained opposition to proposed legislation that would infringe civil liberties and free speech, for example, ministers spoke in apocalyptic yet general terms about security and the threat of terrorism. The right to life was the greatest human right of all became the mantra of the moment".
	Of course, that applies to all sorts of things. It is implied that if Olympic pistol shooters are allowed to practise using .22 pistols in this country, the murder rate will shoot up, and if we were to leave the EU, there would be millions of unemployed and mass starvation, and so on.
	If you consistently frighten people into believing that their safety is in peril, it is bound to rebound on you as a government at some point. Let us hope that in this House we can at the very least restore the Bill so that it goes no further in eroding our freedoms than what was proposed in the Labour manifesto.

Baroness McIntosh of Hudnall: My Lords, when I saw that the noble Baroness, Lady Howarth of Breckland, had put her name down to speak in this debate—which of course she would, given her acknowledged expertise in this area—I got an unpleasant sense that she would return to my very disobliging remarks about her when we both spoke in the debate on the London and Liverpool prohibition of smoking Bills last summer. So, first, I want to take this opportunity to apologise to the noble Baroness for casting aspersions on how she conducted her private leisure activities. Despite that, I am not deterred from raising the issue that she observed I probably would raise, and have raised in the past, in respect of this Bill: the impact of Part 1 on the theatre industry.
	I start by declaring my interests, which include being an ex-member of the board of the Society of London Theatre and a current member of the boards of both the Almeida Theatre and the Roundhouse, which is shortly to reopen. I should also say that I entirely support the Bill. I want to make that very clear from the outset. In particular, I support the aspects of it that relate to the restriction of smoking in public places. However, some difficulties arise from it concerning the presentation of live theatre events, and I want to outline them. Before I do so, however, I should like to associate myself with the remarks of the noble Baroness, Lady Howarth, about our late colleague Lord Stratford. I had wanted to refer, as she did, to the fact that he spoke in the debate that she and I both participated in last summer. It was the occasion of his maiden speech, and it seems to me terribly sad that he was not with us long enough to see this issue, about which he felt so strongly, brought to fruition through a government Bill. We shall continue to miss him.
	Three aspects of Part 1 have a direct impact on how theatre presentations can be brought about. First, the definition of "smoking" in Clause 1 is as follows:
	(a) . . . smoking tobacco or anything which contains tobacco; or smoking any other substance; and (b) smoking includes being in possession of lit tobacco or of anything lit which contains tobacco, or being in possession of any other lit substance in a form in which it could be smoked".
	That definition would, therefore, include the smoking of herbal cigarettes—a matter to which I shall return.
	Secondly, the definition of smoke-free premises in Clause 2 is drawn widely enough to encompass not only the public areas of theatres and other places of entertainment, such as auditoria and foyer spaces, but also rehearsal spaces and all indoor stages or other performance spaces, although I note the potential specified in Clause 3(5) for regulations to allow certain exemptions.
	Thirdly, the requirements set out in Clause 6 for the provision of "no smoking" signs could, as drafted, result in such signs having to be displayed on stage during performances. At this point, I agree wholeheartedly with what the noble Baroness, Lady Cumberlege, said earlier about the necessity to be scrupulous about how we go forward with the issue of signage. It can be a very heavy-handed way of dealing with the obviously necessary provision of information.
	All those requirements put together could seriously interfere with the production of theatre work within which smoking is either specifically indicated in the text or necessary to convey a particular period, atmosphere or character. I think, for instance, of John Osborne's seminal play "Look Back in Anger", with which I am sure many of your Lordships are familiar. It was written in 1956 and, briefly, it deals with the marital difficulties of a young couple in that era. The main character, Jimmy Porter, smokes a pipe. If he were not to do so, not only would a significant element of the play be lost, as many of your Lordships will know, but the author's copyright would be infringed because he specifies that. It would be improper for anyone to remove from the play that aspect of his writing without the permission of those who act for him now—unfortunately he is no longer with us.
	There are many other similar examples but I will not detain the House by repeating them. I simply reiterate the point that I made on the earlier Bill:
	"The Bill as drafted gives powers . . . both to inhibit the process of creating work for the stage and to compromise the integrity of performance".—[Official Report, 20/07/05; col. 1568.]
	I do not think that it is the Government's intention to place unreasonable restrictions on the presentation of live theatre performance. Indeed, I believe that they are already considering the matter. My honourable friend Caroline Flint, in reply to a Question from the Conservative shadow Health Secretary, Andrew Lansley, on 17 January, said:
	"We received representations from the theatre industry to exempt theatrical performances and will take them into account in drafting regulations"—[Official Report, Commons, 17/01/06; col.1307W.]
	Will my noble friend confirm this intention and say when it is anticipated that draft regulations will be available? Perhaps I could further encourage him by pointing out that in New York—a city now notorious for the draconian way that anti-smoking regulations are enforced—actors are permitted to smoke herbal tobacco on stage and in rehearsal, subject only to the proviso that if there is smoking on stage, the public must be alerted in much the same way as they are alerted to the use of strobe lighting or explosive sound. It surely cannot be impossible for this Bill to be amended to create similar flexibilities with appropriate safeguards.
	In case it should occur either to my noble friend or any other of your Lordships—the noble Baroness, Lady Howarth, in particular—that perhaps this suggestion is an evil plot by wicked theatre producers to force their hapless employees into unhealthy practices against their will, I should record that Equity, the actors' union, has also raised these issues with the Government.
	On the question of glamorising smoking, I have some sympathy with the noble Baroness, but there is a difference between an active wish to glamorise the act and simply representing the act as part of a theatre performance.
	I recognise that this is a relatively minor matter in the great scheme of things, but it is not insignificant. The move to end smoking in public places is a hugely important step in promoting public health, as many of the previous speakers have said. It has my full support. None the less, as I have said before, smoking, though dangerous and undesirable for many reasons, has been part of our own and other cultures for hundreds of years and its presence in, and impact on, art cannot be ignored or legislated away. We need to find acceptable ways of allowing it to be represented. I hope that the Government will feel able either to bring forward suitable amendments in Committee, or to consider sympathetically suggestions from others.

Lord Colwyn: My Lords, at this stage of a debate there tends to be some repetition, particularly of statistical evidence. However, I welcome the Bill and the changes that have been made in the other place. The other place has been discussing dentistry this afternoon. Normally, when speaking on a health Bill I can steer it round towards dentistry. The Minister will be delighted to hear that that has not proved possible this evening.
	Although most smoke-related deaths are caused by passive smoking at home, about 500 each year are due to exposure at work. This exposure is particularly high in the hospitality industry and is likely to affect bar workers and, indeed, musicians. Perhaps I have been lucky, having played my trumpet for more than 40 years in smoke-filled bars, clubs, hotels, and marquees without—as yet—a smoke-related problem. I commend the work of the Roy Castle foundation on this particular issue. Roy died from lung cancer at an early age, and passive smoking was thought to have been the major cause of his disease.
	Although I dislike any nanny-state regulations and the restriction of freedom of choice, I did think that the provision of smoking areas and smoke extraction could go a long way to lessening the risk. It was a regular subject for discussion during my time as chairman of the Refreshment Department, and the committee tried to accommodate the wishes of all members. I am sure that the matter is still being discussed regularly. However, my medical training and the statistical evidence has convinced me that the introduction of smoke-free policies will improve public health, or generate long-term health improvements and reductions in health social inequality. These benefits must override the issues relating to freedom of choice.
	I am proud to have been present for one of Sir Richard Doll's early lectures on the association of lung cancer and smoking many years ago and, like the Minister, I pay tribute to his work on this subject. At one time, I thought that a ban in public places would increase smoking at home, but the evidence now shows that where smoke-free workplaces and enclosed public places are accepted, there tends to be less smoking at home. That is clearly the case following the ban in Ireland. The legislation could lead to a million people quitting smoking. Thousands of lives will be saved and the economy will benefit by about £4 billion.
	I shall now stress some of the points made by the noble Baroness, Lady Murphy. For many years I have thought that there should be changes in working practices in community pharmacies to allow pharmacists to make best use of their skills and experience for the benefit of the public. I was attached to Boots via the Industry and Parliamentary Trust when it widened its policy to build consultation areas into its pharmaceutical outlets for direct patient advice. Doctors should not have to spend time on minor illnesses and infections when practice nurses and pharmacists are equipped by their qualifications to deal with this important aspect of primary care.
	The Bill deals with many of the issues of concern relating to supervision and responsibility in a pharmacy. Pharmacists will be allowed more freedom to begin to provide some of the other services set out in the newly negotiated community pharmacy contract. A responsible pharmacist will have professional accountability for all processes in the pharmacy and will be able to carry out other duties, such as visiting patients and meeting local GPs, when pharmacy activities can be delegated to appropriately trained pharmacy technicians. That is to be welcomed.
	When I first read the Bill, I was concerned that it might affect the regulations currently applied to the way drugs and medicines are stored and dispensed by groups of general practitioners who effectively run small pharmacies within their practices. This issue is not covered by the many pages of briefing notes that I have received, so I assume that there will be no change in the current situation. But will the Minister specifically confirm that the Bill will not affect this vital and essential service, and that suitably trained doctors' dispensers will continue to dispense without the supervision of a pharmacist? That is particularly important in rural areas, where pharmacies can be many miles from the doctor's surgery. I ask for confirmation as I am aware that the relationships between community pharmacies and doctors' dispensing outlets are not always ones of mutual agreement, yet they are essential for the efficient management of many practices.
	I also welcome the provisions in the Bill relating to healthcare-associated infections. This is a major problem that is not under control, and I am concerned that the final version of the code of practice will be unnecessarily delayed by the decision that it should not be published until the Bill receives Royal Assent. The latest figures for MRSA reveal that the NHS will not achieve its goal of cutting rates by 50 per cent within the next two years. The number of deaths linked to MRSA has risen by 22 per cent. Research has shown that up to 100,000 patients admitted to hospital each year were unknown carriers of MRSA. I should have thought that identification of those carriers should be fairly straightforward and an absolute priority.
	The need for the code to be relevant to all health care, and its relationship to hospital design, staff-patient ratios, bed occupancy, isolation facilities, and a clean air environment, must be addressed urgently. Finally, a brief comment on the supervision of management and the use of controlled drugs, as that directly affects my own work when I have to order drugs, store them, carry them with me, and prescribe and use them in different situations. I hope that the Minister can confirm that this legislation will not affect the right of healthcare professionals to prescribe these drugs.
	I welcome the response to the Shipman inquiry and the fact that routine monitoring and inspection of controlled drugs in community pharmacies is likely to become a role undertaken by the pharmacy inspectorate of the Royal Pharmaceutical Society.
	Clause 19 refers to,
	"A constable or an authorised person",
	being able to enter premises. Pharmacy bodies have been negotiating on the inspection of controlled drugs in England, but not in Wales or Scotland. Given the preparations for the transfer of this role to the Royal Pharmaceutical Society inspectorate, I know that they are keen to receive clarification on this issue.
	While welcoming the Bill, I am concerned about the sheer volume of detailed provisions that will be enacted through regulations that will have little scope for amendment once made. I hope that the Minister will be able to set out as much detail as possible in the Bill.
	I am delighted to be followed by the noble Lord, Lord Walton. The last time he followed me was at the Macmillan concert, when he performed in a Geordie accent, but I shall not tempt him this evening.

Lord Walton of Detchant: My Lords, I am a fervent believer in the rights of the individual and in personal freedom. That leaves me free to indulge in a habit, if I so wish, such as smoking, if I am alone, but it does not give me the right to indulge in a habit such as smoking in the presence of other individuals who thereby could be seriously harmed. That is one of the core principles underlying the Bill as amended. I am very glad to see the noble Lord, Lord Naseby, back in his place because the attitude of the medical profession has undergone a sea change over the past 50 or 60 years on this issue.
	Many years ago, when I was a medical student, the professors of anatomy and physiology recommended that we should all smoke, particularly in the dissecting room, as it would help to dispel the odours. More than 60 years ago, when I was in the Army as second in command of an army hospital ship in the Royal Army Medical Corps, I used to buy a 50-can of Senior Service every other day and I got through it in two days. It cost one shilling and eight pence and I smoked 25 cigarettes a day. Then, when Sir Richard Doll produced his first paper, with Bradford Hill and others, I began to see that there were some risks in smoking. However, the evidence at that time suggested that pipe smoking was less dangerous than cigarette smoking, so I moved on to a pipe. In another 10 years' time, the risks associated with pipe smoking of tobacco—indeed all tobacco consumption—became increasingly clear and I gave up nearly 40 years ago. For a time I had that feeling, like Lady Macbeth:
	"Is this a [pipe] I see before me, its handle towards my hand? Come, let me clutch thee! I have thee not, but yet I see thee still".
	I give that personal history because, since that time, the evidence on direct, personal smoking has accumulated steadily and progressively, not only in relation to cancer of the lung or cardiovascular disease, but also in relation to many other cancers. I can quote to my noble friend Lord Skidelsky, although I shall not tonight, the massive volume of statistical evidence that has clearly underlined the facts relating to this matter.
	Some 20 years ago, I chaired a conference at Green College, where I followed Sir Richard Doll as the warden, on the effects of passive smoking. We took a lot of evidence from skilled individuals, such as statisticians, doctors, scientists, and from members of the public. We came to the conclusion that there was anecdotal evidence suggesting that perhaps passive smoking might be harmful. In the past 20 years, the statistics have steadily accumulated and the evidence is now absolutely cast-iron. There is a very large body of scientific literature that makes that point clear. As my noble friend Lady Howarth said, the BMA published evidence last March showing that second-hand smoke is likely to be responsible for the deaths of more than two employed people every working day—more than 600 deaths a year—and at least one employee in the hospitality industry dies each week—54 deaths a year—from passive exposure to tobacco smoke.
	I appreciate what was in the Government's manifesto, but I congratulate the Members of another place on their good sense in introducing the amendments to change the Bill from what had originally been in the manifesto to enact a total ban on smoking in public places, including private members' clubs. I would be delighted if the Bamburgh Castle Golf Club, of which I am president, enacted a ban on smoking. The noble Lord, Lord Geddes, who is not in his place, won a competition there a few years ago. I believe that will be very important because everyone, including those working in private clubs and pubs that do not serve food, has the human right to work without being exposed to poisonous and life-threatening substances. For that reason, the provision relating to private members' clubs is very important.
	On the points made by the noble Lord, Lord Naseby, on ventilation, I commend to him the parliamentary brief from the British Medical Association with a series of very precise references to scientific research studies in Europe, which demonstrate that,
	"displacement ventilation technology cannot remove the gases and particles from the air".
	Perhaps that can be done partially, but it certainly cannot be done to an extent that will be really effective.
	Statistics have been bandied about. The president of the Royal College of Physicians, in evidence to the House of Commons Select Committee, said,
	"there is nothing that this Government could do for health that would be better than to bring in this ban—absolutely nothing".
	I agree with her entirely. The Royal College of Physicians estimates that some 12,000 deaths per year occur from passive smoking, but the great majority of those occur in the home. The figures for the workplace are very much smaller, at 500 to 600. Most of the deaths are caused by passive smoking at home, but exposure is particularly high for some workers in the hospitality industry. Preventing passive smoking at home, particularly for children, is, therefore, a public health priority. Home exposure is prevented only by encouraging parents and carers to quit smoking completely by making homes completely smoke-free. I agree entirely with what the noble Lord, Lord Colwyn, said. There is a widespread misconception that banning smoking in public places will lead to an increase in tobacco consumption in the home. In fact, the reverse is the case. There is now growing evidence that where smoke-free workplaces and smoke-free enclosed public places are the norm, parents report that they are more likely to try to prevent smoking in the home. In Ireland there has been a significant increase in the percentage of smokers who ban smoking in their own homes. I firmly and warmly support Clause 1 of the Bill as amended in the other place. I believe it will make a massive contribution to public health.
	I shall comment briefly on Parts 2 and 3. The Royal College of Nursing welcomes the action that is now proposed to tackle healthcare-associated infection. But they have some specific concerns, which the Minister may be able to allay, relating to the scope of the code of practice, the timetable for introducing the final code of practice and the need to ensure that the code for acute settings is not just transferred to the primary and independent care settings without consultation on its impact. That is particularly important in relation to care homes, as other noble Lords have said. Others have pointed out the concern expressed by the Royal College of Nursing about the definition of healthcare-associated infection. They much prefer the definition of the Health Protection Agency and not the one in the Bill. I hope that the Minister will be able to comment on that.
	I turn to Part 3 and the anxieties expressed by the Royal Pharmaceutical Society of Great Britain, which wants assurances that it will be an active participant in the drafting of the regulations which, as the noble Lord, Lord Colwyn, said, are likely to come thick and fast once the Bill has become law. The legislation should clearly define those activities that can be undertaken only when the responsible pharmacist is present and should include clear lines of accountability, provisions for the responsible pharmacist to be contactable when absent and in a position to return without undue delay, and provisions for the responsible pharmacist to justify any absence from the pharmacy.
	Clause 19 refers to,
	"A constable or an authorised person"
	being able to enter premises. Given the preparations for the transfer of that role to the RPSGB inspectorate, it believes that the role of the Royal Pharmaceutical Society in inspecting pharmacies should be stated on the face of the Bill, over and above the role of the constable.
	Those are the points that I wished to make at Second Reading. I hope that your Lordships will give warm support to the Bill in general, but will be prepared to look at some of the points that I have raised when it comes to Committee stage, in particular the strong support that we have heard from all sides of the House for the ban on smoking in enclosed public spaces.

Lord Stoddart of Swindon: My Lords, the noble Lord, Lord Walton, mentioned Sir Richard Doll. I distinctly remember hearing the late Sir Richard saying on the "Today" programme that he would not favour a ban on smoking in public places. We should keep that very much in mind in view of the fame that he has in relation to smoking. I must declare an interest because although I am not a smoker—I have not smoked for many years—I am a member of the Lords and Commons pipe and cigar smoking club. I find the company I keep there very congenial indeed. The second-hand smoke of the other members does not worry me one bit.
	Going home last night in my car, I was thinking about my life in politics. I have been in politics virtually all my life: I joined the Labour Party in 1947, which was a long time ago. I well remember the late Lord Shawcross, when he was Attorney-General, getting up in the House of Commons and saying, "We are the masters now". There was outrage at that statement because it was just after the war and people had memories of the master race. But it was not only that, because at that time the people who represented other people in the House of Commons believed that they were there not as masters of the people, but as the servants of the people. Elected representatives forget that at the country's peril. I believe that that is what has happened in the House of Commons in relation to this Bill.
	The duty of elected representatives is to ensure justice and fairness to all citizens, even minorities. Indeed, we hear a lot from the present Government about safeguarding the rights of minorities, except, of course, smokers. If you are a minority smoker, then you are everybody's butt and the order is to get rid of you as soon as possible, to get rid of the awful habit. That is not democracy; it is autocracy at its worst. I regret that the House of Commons rejected the just and fair way to deal with smoking in public places, which is separation to give consideration both to smokers and non-smokers, and instead used the most vicious authoritarianism and divisiveness to deal with the problem of so-called passive smoking.
	What about the manifesto commitment that was referred to by the noble Lords, Lord Geddes and Lord Monson, and perhaps by other noble Lords as well? The noble Lord, Lord Geddes, referred to what the Leader of the House said in relation to the future of this House two days ago. However, we have a more up-to-date comment than that. Yesterday, in the debate on Commons amendments to the Terrorism Bill, the House was told that it must abide by manifesto commitments. The noble Baroness, Lady Scotland, said:
	"the manifesto said:
	'we will introduce new laws to help catch and convict those involved in helping to plan terrorist activity or who glorify or condone acts of terror'.
	I respectfully suggest that that could not have been clearer. We should demonstrate to our electorate that we take its views seriously".—[Official Report, 28/02/06; col. 137.]
	There could not be a clearer statement than that that the Government wish to honour their manifesto commitments—except, apparently, in respect of smoking because, as we have heard, the manifesto has not been adhered to. Yesterday, we were being told that we must honour manifesto commitments; today, we are being told to ignore a manifesto commitment. The Government cannot have it both ways.
	Of course, the Government think that they have got out of it by having a free vote, which is a government device to get around the manifesto. But every Labour Member of Parliament was bound by that manifesto. They went to the electorate on it and they fought the election on it, so they have the same duty as the Government to ensure that it is carried out. Labour MPs cannot ignore manifesto commitments with impunity while everybody else apparently has to comply with them to the letter. I am afraid that Britain becomes more like a one-party state every day when this sort of thing goes on.
	This legislation is being claimed as a measure to protect the health of people in areas where people smoke. All sorts of figures—we have heard some of them this afternoon—have been bandied about on the numbers involved. As has already been said today, in November last year, Patricia Hewitt, the Secretary of State for Health, said that 54 people from the hospitality industry and 617 from other workplaces die in Britain every year from the effects of second-hand smoke. That is statistical evidence. The noble Lord, Lord Skidelsky, dealt very well with the statistical part of this matter this afternoon. He will be quoted all over the world, make no mistake about that. The figures that he gave were very significant and came from an expert source. However, no clinical evidence has been produced, only statistical evidence. We are still waiting for clinical evidence. The figures are simply estimates.
	Those figures pale into insignificance compared with the number of deaths from alcoholism. That number is many times greater—and I have not mentioned fights and killings outside public houses and the injuries that they cause, or wife and child beating. People who are interested in social affairs should consider the wives and children who are beaten up by drunks when they go home after drinking too much every Saturday night, and perhaps every night of the week. What about them? And, of course, there are the millions of days that are lost through overindulgence in alcohol and the damage that that does to the country's economy.
	On the basis of actual harm, not simply of statistics—and it is actual harm; we know about the children and the wives who are beaten, and the people who are knifed outside the pubs—it would be more sensible to ban alcohol, rather than smoking, in public places. But, of course, no one would suggest that, would they? Well, not at the moment, although that time may come under this Government. If they can get away with a ban on smoking in public places, who knows where they will ban it next? The noble Baroness told us today what the next step is—a complete ban on smoking at home or wherever else. Just think of the problems that that would cause with policing and people interfering in people's homes.

Baroness Howarth of Breckland: My Lords, I did not want to intervene, but that suggestion has been made twice. I simply said that I hoped that we could stop people smoking around children in their own homes. I said earlier—if the noble Lord cares to read my speech—that that was one of the things that we could not do. I believe that I was the one who was referred to twice. I think that there is freedom, but freedom means being conscious of the damage that you are doing, particularly to your own children.

Lord Stoddart of Swindon: My Lords, may I interrupt the noble Baroness? I did not quote her; I am sorry if she misheard what I said. I quoted the noble Baroness, Lady Rendell of Babergh. I am sorry that she took my remarks amiss, but they were not addressed at her.
	Then, of course, there are the dangers to health from vehicle emissions; estimates of deaths in the United Kingdom vary from 10,000 to 30,000 a year. According to the Mayor of London—he is still there for the moment—1,000 people in London alone die from vehicle emissions, not to mention from diseases such as asthma, which are exacerbated by traffic fumes. People will step out from smoke-free pubs and so on into the foul atmosphere of traffic-congested streets, and also risk being one of the 3,500 killed and 45,000 seriously injured on the roads each year.
	The whole anti-smoking campaign has been driven to the present situation through the creation of fear and hysteria among people that second-hand smoke is one of the greatest health risks, although I have just given two examples to show that it most certainly is not. But people tend to accept the myth of greater danger from second-hand smoking because the medical profession embraces it. We all respect medical practitioners and listen intently to their views, but we need to ask ourselves whether it is more dangerous to go into a smoke-filled bar or a hospital. There are roughly 5,000 cases of medical negligence every year and, according to the BMA, there are at least 5,000 deaths per annum from MRSA. Some 300,000 patients pick up an infection in hospital each year, some of which leads to death or permanent disability. Those are not my figures—they come from a report published by the BMA's Board of Science and Education on 20 February. Is it really more dangerous to go into a bar than a hospital? Of course it is not, according to those figures. Personal hygiene among doctors and nurses is thought to be a significant cause of these infections, and patients are now being advised to ask their doctors whether they have washed their hands between dealing with patients. That is where we have got to with health and doctors.
	Then there is the new scare of obesity. When I was a lad growing up in the Rhondda Valley during the depression, we were not worried about obesity; we were worried about almost skeletal children. Now, the new problem, in addition to smoking, is obesity. It is said to be costing the NHS £6 billion a year—that is three and a half times more than the Government say smoking costs the NHS every year. So why are we talking about passive smoking? Obesity is also supposed to shorten the life span. Perhaps House of Commons man will introduce a Bill soon to ban eating in public places.
	I quoted these figures to try to show that we have got our priorities wrong, that the evidence for a ban on smoking in public places is tenuous and based on estimates rather than clinical certainty, and that the whole argument about smoking has been whipped up by assertions from witch-hunting bigots who pretend that smoking is the most dangerous activity in the world, which it is certainly not. I think that it is a national disgrace that we have a House of Commons that, in a debate of only three hours to discuss this great matter, has stripped people of rights that they have enjoyed for hundreds of years, despite a manifesto commitment not to do so. Separation and good ventilation would produce a solution satisfactory to most reasonable people and, with others—at least, I hope that there will be others—I will seek to achieve this at least by amending the Bill to the limits included in the Labour Party manifesto.

Lord Palmer: My Lords, it is a pleasure to follow the noble Lord, Lord Stoddart of Swindon, although it is a difficult act to follow on this occasion. I, too, would like to thank the noble Lord, Lord Warner, for introducing this Bill. I feel very humbled to be taking part in the debate among such a distinguished line of speakers, most especially my colleagues on the Cross Benches from the medical world.
	As the last speaker, I have three very brief points that I would like to make, and I propose to introduce amendments to two of them under Part 6 of the Bill. The first is prescription charges. I used to correspond with the noble Baroness, Lady Cumberlege, on this point when she was at the Department of Health. I have always felt very strongly that all prescription drugs ought to have their value clearly printed on them, so that patients know exactly what they are getting for the prescription charge. I have always thought that this was a particularly good idea, because some of these drugs are outstanding value for money.
	My second point is also an old hobbyhorse of mine. In order further to reduce the waiting lists and the heavy load on the National Health Service, I have long advocated that insurance health premiums ought to be allowed against income tax. For those of us in this House who have health insurance, it is a very large proportion of one's expenditure, particularly if one has a wife and, say, three or four children.
	Finally, I turn to the vexed question of smoking. My views are well known and are certainly well documented in Hansard, from when we last discussed smoking. I echo the views of my noble friend Lord Monson, and the noble Lords, Lord Geddes and Lord Naseby. Particularly bearing in mind what the noble Lord, Lord Stoddart, said, I find it difficult to believe that a party in power can go so directly against its manifesto commitment.
	If you own a restaurant, you have to staff it and pay all the financing. Therefore, if you want someone to work in that restaurant you can, after all, explain, "I am sorry, this is a restaurant where smoking is allowed. If you want to work here, you will have to accept that". There are, of course, plenty of other places where that person could work.
	In theory, I applaud the Government for wishing to limit the amount that people smoke. For years and years I have thought that the only way to stop people smoking is to have a blanket ban on the sale of all tobacco products. I know that we would have a bit of a problem because at the moment, 27 per cent of tobacco products sold in this country are smuggled in. However, I believe that if the Government really want to stop people smoking, the only alternative is to ban the sale of all tobacco products, and I intend to produce an amendment to that effect in Committee.

Lord Clement-Jones: My Lords, I thank the Minister for his succinct introduction to the Bill. I also thank my noble friend for her trailer, football metaphors included, although in this House, being on the Bench has a rather different meaning.
	I am tempted to start with the words, "As I was saying July 2004". I have a strong sense of déjà vu when I look at some elements of the Bill. The Government claim to have been fighting the battle against MRSA and now VRSA and C. Difficile over the past few years. Every year they use a new set of targets or guidelines or launch a new campaign and assure us that the battle is nearly won in the face of all the available figures.
	The latest bright idea is a legally binding code of practice incorporated in the Bill. I am extremely sceptical whether the legislation will make the situation any better. This is a basic management and infection control issue in our hospitals. I commend the analysis and prescription of my noble friend Lady Barker in this respect.
	As regards Part 1, I have no sense of déjà vu, unless you count some of the hyperbole being displayed by some of its opponents and the massed ranks of the Lords and Commons Pipe and Cigar Smokers' Club, who were present when I was lucky enough to sponsor the Tobacco Advertising and Promotion Bill. Part 1 is the product of the other place at its very best—a bold legislative step to ban smoking in public places, including all pubs and private clubs, taken as a matter of individual judgment by MPs on a free vote.
	Despite the claims of tobacco company spokesmen and organisations such as FOREST, it is, as the noble Lord, Lord Walton, made clear, no longer a question for serious debate that second-hand smoke is harmful and leads to premature death. The key issue is the estimated number of deaths caused by inhaling other people's smoke. I listened to the noble Lord, Lord Skidelsky, with mounting incredulity—his use of statistics was quite extraordinary, and I hope that the Minister will demonstrate the proposition against.
	The paper in the British Medical Journal by Professor Jamrozik of 1 March 2005 demonstrates that we are talking about a minimum of 600 people a year. That is three times the number killed each year in industrial accidents. There are many other estimates which are much higher. I have seen printed documents—

Lord Skidelsky: My Lords, as the noble Lord referred to me, I am grateful to him for giving way. What does he understand by 600 premature deaths?

Lord Clement-Jones: My Lords, if you read the paper, as I am sure the noble Lord has, there are deaths that are earlier than might have been anticipated. The professor has presented a very respectable piece of work, it is peer reviewed, and we can argue about the definitions. The fact is that it refers to a minimum number.
	The noble Lord will no doubt have read many other papers—the noble Lord, Lord Walton, referred to a number of them—which give far higher estimates. The Greater London Assembly has a printed document that refers to 10,000 individuals in London alone. The figures are very high and it is only responsible to use the latest ones, as many other speakers, including the noble Baroness, have. On the basis of that minimum number, we argue in favour of Part 1. We are not talking in hyperbolic terms but in a responsible, level-headed way on the basis of research that has been carried out. This minimum figure is three times the numbers killed each year in industrial injuries.

Lord Naseby: My Lords, the noble Lord did not answer the noble Lord, Lord Skidelsky. How much earlier are these 600 people dying—is it months, years, days?

Lord Clement-Jones: My Lords, this is a matter of statistical analysis. I am perfectly willing to rely on the contents of the paper. If the noble Lord has read it, I am sure he will challenge me further down the track.

Lord Walton of Detchant: My Lords, it is not the question of months or years that is relevant; that is why I could not understand the argument of the noble Lord, Lord Skidelsky. It is the fact that people died from smoking-related diseases who would otherwise have died from something else.

Lord Clement-Jones: My Lords, I am content to rely on the analysis of the noble Lord, Lord Walton.
	To return to the fray, the analysis of the noble Lord, Lord Skidelsky, is that it is an average of 15 minutes per person. It all depends, I suspect, on who you are. If the finger points at you, it is not a question of 15 minutes—you are subject to passive smoking and you are dying prematurely.

Lord Skidelsky: My Lords, to correct that point, I never referred to 15 minutes. The noble Lord will see that if he reads my speech.

Lord Clement-Jones: My Lords, I am quite content to rely on Hansard when the time comes and see whether it was four days or 15 minutes in a different context. I will certainly look at that. Four days is pretty hyperbolic in my book.
	The BMA's 2002 report concluded that there are at least 1,000 preventable deaths every year as a result of passive smoking. The side effects include lung cancer, heart disease, respiratory disease, middle ear disease and asthma attacks. We have heard that both the BMA and the Royal College of Nursing support a complete ban in enclosed public spaces and we on these Benches agree. Alone among the parties, we included that in our manifesto at last year's general election. A partial smoking ban would have continued to leave workers at risk of the effects of second-hand smoke. That is why we welcome Part 1 as it left the other place.
	If an exemption had been left in place for pubs not serving food, pubs currently serving food might well have stopped that facility if so doing would have allowed them to qualify as exempt. Various noble Lords have waxed lyrical on the virtues of licensed clubs. Exempting licensed clubs—there are some 20,000 of them—would have driven a coach and horses through the Bill. Why should workers in pubs be entitled to be protected but not those in private licensed clubs? I see no logic in exempting licensed clubs.
	A further advantage of a total ban is that as lower-paid workers such as bar staff are exposed to higher levels of second-hand smoke than other workers it will help to reduce health inequalities. Furthermore, under the previous provisions, 45 per cent of the pubs in the most deprived areas would have been exempt compared to 14 per cent in the least deprived. There are strong issues in addressing health inequalities derived from Part 1 as well. Having visited Ireland, as the noble Baroness, Lady O'Cathain, mentioned, I am convinced that the issue of compliance and enforcement will not loom large. If Ireland can enforce the law and publicans and others can ply in the way that they do to a large extent, then, frankly, in England, Scotland and Wales we will be able to do the same.
	I turn to ventilation systems, which the noble Lord, Lord Naseby, mentioned. While removing the smell of smoke, they cannot effectively remove the harmful chemicals in smoke. Recent research from Australia has shown that designated no-smoking areas in hospitality venues provide at best partial protection and at worst no protection at all against the effects of second-hand smoke. Ventilation is not affected and any smoking indoors will continue to pollute the air. Indeed, the paper's summary says that tornado-like qualities of ventilation are needed to have any effect. To rely on ventilation as a panacea is relying on something that is not a reality.
	It is even clear that a ban on workplace smoking, including pubs and clubs, is popular, as the YouGov poll taken last December showed. The arguments for a total ban are founded on health and safety grounds, as many noble Lords have made clear. For reasons of protection of the workforce and fellow residents or inmates, I also favour a complete ban on smoking in care homes and prisons. I hope that during Committee we will be considering that matter, which was also mentioned by the noble Baronesses, Lady Rendell and Lady Masham. I also wholeheartedly take on board the points made by the noble Baroness, Lady McIntosh. We cannot simply airbrush out of our artistic culture the fact that over many years people have smoked; whether it is represented on the stage, in films or in other forms of art. On these Benches we are sympathetic to that point, particularly in my role as a DCMS spokesman; I am only here on loan, as my noble friend made clear.
	This is a basic health and safety issue. A smoke-free environment should be the norm where non-smokers work. They should have the freedom to work in an environment free of damaging substances. That is where I believe that the freedom issue lies; not in the freedom to smoke in the presence of others, but being free of other people's smoke that can damage one's health. The Government do not and should not seek to legislate over individuals' smoking habits in their own homes. By the way, noble Lords who said that there would not be displacement were entirely right. None of the evidence demonstrates that there will be displacement as a result of a public smoking ban. It is the Government's role to provide a safe environment in enclosed spaces in the public sphere and where people work.
	In addition to the immediate effect on employees and customers, there are of course wider benefits to be reaped in banning smoking. Such a ban would clearly help to reduce smoking in the population at large. That can only be a good thing. No-smoking laws have been shown to support smokers to quit. In Ireland, a survey by the National Smokers' Quitline service revealed that about 10,000 smokers reported that they had reduced their consumption since the ban came into force. According to the Irish Revenue Commissioners, cigarette sales fell by nearly 16 per cent in the first six months of the ban. I am sure that the noble Lord, Lord Naseby, will have views on those facts, but they are the facts that I have to hand.
	Similarly, in New York City there are now an estimated 200,000 fewer smokers than when a ban was introduced in 2002—a 15 per cent decrease. Smoke-free laws have also reduced smoking rates across all population groups. Surely a similar effect in England would be good news for the nation's health. As we have heard, the Government's own estimates suggest that a smoking ban would encourage some 600,000 to 700,000 people to give up smoking.
	Crucially, research by the Chief Medical Officer has shown that fewer young people would take up smoking if their workplace was smoke free, possibly reducing smoking rates by a third among the 300,000 16 year-olds who start work each year. Opponents have raised spurious economic figures to show the damage to the hospitality sector, but if we take the Irish experience, which is close to what we expect ours to be, the volume of sales in beer, wine, spirits and food in pubs rose by 5.3 per cent in the year to last October, and the value of sales by 4.2 per cent; which reverses a longstanding decline in sales of those products in previous years. The same is true in New York according to the New York City authorities. In fact, estimates by the Chief Medical Officer are that a ban could benefit the British economy by up to £2.7 billion; an impressive figure.
	Finally, we should note the words of the BMA's head of science and ethics, Dr Vivienne Nathanson:
	"The medical profession is united in its calls for a total ban on smoking in all enclosed public places and workplaces. Recent research reports that second-hand smoke kills 30 people each day. The situation in New York, Ireland and other cities and countries that have gone smoke-free show that these policies do not harm business, they do not cost jobs. The policies are popular, they encourage people to quit and they protect health and save lives. What possible argument is there for not implementing a total ban?".
	The Bill also has the benefit of bringing England in line with Scotland, which has passed legislation introducing a ban on smoking in all enclosed public places that will come into force on 26 March. The Welsh Assembly also last year voted for a complete workplace ban. I hope that England will follow that example and I wholeheartedly support Part 1.

Lord Monson: My Lords, will the noble Lord, Lord Clement-Jones, clarify one point before he sits down? He said that noble Lords on his Benches would be supporting the Bill as it emerged from the Commons. However, in the other place seven Liberal Democrat honourable Members voted for an exemption for private clubs. Is he saying that unlike in the Commons, Liberal Democrats in this House will not be permitted a free vote?

Lord Clement-Jones: My Lords, that is an interesting point. I will rely on the usual ministerial response that I will have to ask the usual channels. I cannot commit our Whips to any such thing, whether it is a free vote or not. I can speak only for myself and the health team. I believe that we will have a rousing vote for Part 1, especially since it is a manifesto commitment. We might indeed wish to go further, as I indicated in my speech, in terms of banning smoking in care homes, prisons and so on.

Earl Howe: My Lords, this has been a very good debate, which has generated a good deal of what this House enjoys and is good at: well-informed opinions trenchantly articulated. It has been far from the damp squib that some of us thought it might be a couple of days ago when the list of speakers was extremely short. As all the contributions have demonstrated, the Bill presents us with a variety of disparate themes thrown together inside a single wrapper. There is nothing wrong with that, but in any job of summing up such a debate, seamlessness will not be an attribute much to the fore. My initial comment to the Minister is that the greater part of what the Bill contains is uncontroversial and that a great deal of it deserves a welcome and a fair wind. Those parts that do not fall within those descriptions are perhaps self-evident from speeches today.
	I wish to start with the positive. All of us were aware, as the details of the Shipman case emerged, that an official inquiry into it would be a near certainty and that recommendations would ensue that probably would require legislative change. I am very pleased to see provisions in Part 3 of the Bill that respond to the concerns expressed in Dame Janet Smith's fourth report about the use and monitoring of controlled drugs. The measures proposed appear in the round to be sensible and proportionate, even if they are not quite what Dame Janet recommended. I am not sure what led the Government to favour the idea of creating accountable officers ahead of Dame Janet's concept of an inspectorate. If we were looking at an inspectorate, the most obvious candidate, certainly in the case of community pharmacies, would be the Royal Pharmaceutical Society of Great Britain, which already has an inspectorate. It would be helpful if the Minister commented on this.
	Setting that matter aside, if we table amendments on this part of the Bill, they are likely to relate to issues of detail and practice, rather than principle. That comment applies in equal measure to the provisions in Part 4, relating to fraud, and to the whole of Parts 5 and 6, which are not contentious.
	I listened carefully to what the Minister had to say in relation to Clauses 25 to 32, covering medicines and pharmacies. We shall probably wish to probe these issues in Committee, because while we all subscribe, I am sure, to the notion of a wider role for community pharmacists in delivering patient care, it would be wrong to try to achieve this at the expense of patient safety. I should like to be quite confident that allowing drugs to be dispensed by unsupervised pharmacy staff will not open up such risks. We also need to be clear about precisely what activities a pharmacist needs to oversee and how wide his empire of responsibility ought properly to be. The issue boils down to what is entailed by the phrase "responsible pharmacist" and exactly how the current rules are to be varied. These are matters to be explored. It is regrettable that so much is to be left to regulations.
	I listened carefully to the Minister's explanation of the proposals relating to ophthalmic services. He will know that there is considerable disquiet among optometrists about the implications of these proposals. We have had a system that has worked perfectly well up to now, so why change it? And why change it without consultation and in advance of the review of general ophthalmic services? If we change it, and give PCTs the responsibility for commissioning services, the fear is that budgets will leach away into other patient services where funding is under pressure, that PCTs will be tempted simply to go for the cheapest option and that, as a result, the quality and range of ophthalmic care will diminish, with possibly fewer officially approved practitioners for the public to go to for eye tests. That may not be the Government's intention, but the fear exists. We shall need to explore the rationale and the practical implications thoroughly. What we all want to see, and what the profession is without doubt capable of delivering—if it is allowed to—is an even better and even more innovative service to the patient. That should be what we aim for here.
	We have debated on a number of occasions in this House the vexed issue of healthcare-associated infections. I shall not make this an opportunity to bash the Government, but the Minister will know very well the number of initiatives that the Department of Health has already put in place to try to combat this problem during the past few years. I have no objection to the idea of a statutory code, but the question which we have to ask, and which has been asked a number of times today, is whether a statutory code will really make the crucial difference. What matters is that hospital staff should follow the proper procedures. The existence of a code is fine as far as it goes, but it will not affect behaviour; nor, I fear, will the issue of an improvement notice by the Healthcare Commission, which already has extensive powers to audit and criticise hospital practice. It is the extent to which staff—all staff, and not just doctors and nurses—are motivated to do the right thing and are held to account if they do not that will make the difference. Whenever corners are cut in hospital hygiene, it has a lot to do with time pressure, lack of access to washing facilities and high levels of bed occupancy. These are very difficult problems to overcome.
	Where the Government are right is in making it clear that good hygiene is not, and can never be, an optional extra. It is a top priority. The BMA estimates that about 15 to 30 per cent of healthcare-associated infections are preventable. That figure surprised me, because a lot of hospitals in the NHS have done considerably better than that, but it tends to show that a code of the kind proposed here is not likely to prove to be a magic wand. Once again, we shall wish to test and probe the Government's intentions in this area in Committee. It would be very good if we could see a final draft of the code before then. I do not know whether that is possible.
	I have left 'til last the Bill's most contentious ingredient, on which many noble Lords have focused their remarks today. A legal ban on smoking in the workplace and in all other enclosed public spaces, including bars, clubs and restaurants, is indeed a momentous step for Parliament to take. If the decisions taken in another place are accepted by this House, no government Minister will be entitled to claim credit for them. The Government have been all over the place on this issue. They were elected on a manifesto commitment which amounted to a partial ban on smoking in public places. There were to be exemptions for pubs and bars that did not serve food and for private members' clubs. After the election, the Government had second thoughts. The Cabinet deliberated whether it would be better to go for a more comprehensive ban. Following weeks of discussion, it was decided to stick with the original policy. The Bill was published. The Secretary of State introduced the Bill in another place and defended the policy. Among other things, she stated her firm belief in the right of private clubs to decide on their own smoking arrangements.
	Then, all of a sudden, the policy disappeared. It was goodbye to the manifesto commitment and to the Cabinet decision. The whole issue would be subject to a free vote. On Report, the Secretary of State, along with the Prime Minister and the Chancellor of the Exchequer, did something quite unprecedented, which was to vote against their own Bill, against their own manifesto and against the policy that had been thrashed out in Cabinet and so stoutly defended at Second Reading. The Secretary of State did something even more extraordinary, which was, without warning, to vote against an exemption for private clubs, which she had previously declared as being right. One has to ask what kind of leadership that is from a Secretary of State for Health. Whether or not you agree with government policy, you expect there to be a policy on a matter as important as this and you expect a Secretary of State to give a lead in promoting it. The handling of the Bill, on this major issue, has been woeful.
	Your Lordships face a decision about what to do. My own view, though painful for a number of noble Lords, is that the decision is straightforward. The majorities recorded in the other place, on a free vote, in favour of a complete ban were substantial. For this House to overturn those decisions would not be right. We can, and we should, debate the detail of those decisions and test their practical implications, but I suggest that that is, bearing in mind the role and powers of this House, as far as we should go. I say that with due respect—

Lord Stoddart of Swindon: My Lords, is the noble Lord saying that there will be a free vote on his side of the House? Or is he saying that there will be a whipped vote?

Earl Howe: My Lords, it will be a free vote as far as my party is concerned.
	I have reached my conclusion with due respect to my noble friends Lord Naseby and Lord Geddes and other noble Lords who spoke in the same vein, as well as to the 100 or more men and women from Whitefield in Manchester whose petition on the subject reached me today.
	Perhaps I could also express a personal view. A few years ago, any discussion about second-hand smoke revolved mainly around arguments about its nuisance value. That has changed. The medical evidence set out by the Scientific Committee on Tobacco and Health is unequivocal. Second-hand smoke kills people. It kills a lot of people. It is not simply the increased risk of lung cancer.

Lord Naseby: My Lords, my noble friend says that the evidence is totally conclusive. In that case, why is that evidence not made public? Why are the minutes of the meetings currently redacted?

Earl Howe: My Lords, I cannot answer for the committee or its proceedings, but there is no shortage of evidence either from the committee or from published papers in medical journals that reach exactly the same conclusion. Those were papers that the committee itself reviewed.

Lord Stoddart of Swindon: My Lords, I have not been able to read the study to which the noble Earl refers. Can he say whether it is based on statistical or clinical evidence? Is there a body of clinical evidence to support the figures that he has given us?

Earl Howe: My Lords, I take as my brief what expert medical people tell me. I am in no position to second-guess what they tell me, and I would not dream of doing so. Where we have an authoritative body that advises the Government such as the Scientific Committee on Tobacco and Health, I take it as read that it is composed of people who know what they are talking about. If someone wishes to challenge that, I am ready to listen, but I do not feel sufficiently qualified to do so myself.

Lord Stoddart of Swindon: My Lords, I am most obliged to the noble Earl for again giving way. Would he therefore urge the organisation to publish all the evidence and methodology that it used?

Earl Howe: My Lords, in so far as I have any leverage with that committee, I should be glad to do so. I am not sure whether I am the best person to urge that course, but it is one that I would endorse wholeheartedly.
	It is not simply the increased risk of lung cancer. It is also the significant increase in the risk of coronary heart disease from quite modest exposure to second-hand smoke. In other words, there is a non-linear relationship between dose and risk. Once one accepts the evidence—it is endorsed by every reputable medical body around the world—one has to accept that it is no longer a nuisance issue; it is a public health issue. If it is a public health issue, it is obvious that there is no acceptable halfway house. The Government's manifesto policy to exempt some pubs and bars, but not others, made no sense whatever. The risks from smoke are the same, whether the pub you are in does or does not serve food. In fact, it is worse than that because the areas of the country where the largest number of non-food pubs are to be found are those where there are already poorer than average levels of health. That is why the Chief Medical Officer stated that a partial ban was worse than no ban at all. That is also why I am so critical of the Government. For many months, they led up us a blind alley that was very obviously a blind alley and one that would actually have worsened health inequalities.
	At the last general election, my own party was quite clear: we wanted to bring about a situation in which non-smokers in enclosed public places and at work should not be exposed to second-hand smoke. We would have done that by a different route—by voluntary self regulation and by promulgating a beefed-up health and safety at work policy. The end in view was broader than under the Government's previous policy. However, that is now past. Now that a legislative solution is in prospect, we need to make sure that its full implications are debated in a constructive spirit and understood. That, I suggest, will be our task in relation to this and other issues in the Bill when we reach Committee stage to which I, for one, look forward.

Lord Warner: My Lords, I thank most noble Lords for their support for the Bill. I also welcome back the noble Lord, Lord Clement-Jones. Long may he continue on this free transfer. We look forward to our discussions at later stages of the Bill. I also gently remind noble Lords, such as the noble Lord, Lord Monson—who described it graphically as a health fascism Bill—that there were 47 fascist Conservatives and 47 fascist Liberal Democrats who also joined members of the Government and Labour Back-Benchers in the other place in voting for a comprehensive ban.

Lord Monson: My Lords, I did not describe any individual as fascist, nor would I do so.

Lord Warner: My Lords, I seem to recall that the noble Lord described this as a health fascist Bill, but we shall let Hansard speak for itself.
	We could spend a long time debating the figures. I think that the figures are in the public arena. I shall not go over them again. Noble Lords can interrupt me as much as they like, but I shall not go over the figures again. We spent a lot of time on that issue. The information is in the public arena. If people have a thirst for knowledge they can read the documents. They are well set out in the public arena.
	I wish to clarify any confusion over what I said at the end of my opening speech—I do not think that I confused people—about 600,000 lives. I did not say that 600,000 lives were saved. I apologise if I confused people. What I said was what was in the regulatory impact assessment: smoke-free provisions will lead to 600,000 smokers giving up, not lives saved. That is a 1.7 per cent reduction in prevalence. What that suggests—as I also said—is that many lives will be saved in the long term.
	With regard to some of the issues raised by the noble Lord, Lord Skidelsky, and others, this is not a debate about statistics, about how many people died and to what extent their lives were truncated. I ask the noble Lord and others who shared his views to think about how many people will also have the quality of their life affected as they have their life shortened. Many people are in the position of my noble friend Lord Simon. They may have conditions that are adversely affected. There is a quality of life issue and deteriorating health for many people who are afflicted and have to subject themselves to the experience of second-hand smoke.
	The noble Lord, Lord Naseby, is concerned about the SCOTH report and whether information is being withheld from the public. SCOTH has reported twice in the past eight years, in 1998 and 2004. Both reports have been published. They are in the Library. Their case has been set out. People can read it. They can consider whether they accept or reject it. In addition, the World Health Organisation reported in 2002 classifying second-hand smoke as a known carcinogen.

Lord Naseby: My Lords, the Minister does not answer the question I asked, so I shall put it again. Under the Freedom of Information Act the minutes of that organisation should be available. Why are they not fully available, and why are they redacted at this point in time?

Lord Warner: My Lords, I shall not continue that debate. I have set out our position on the figures. The noble Lord can rise as many times as he likes. This is a Second Reading; we are not in Committee. I shall not give way. I want to carry on with my speech.

Lord Naseby: My Lords—

Lord Warner: My Lords, that is what I wish to do. I wish to continue with my speech.

Lord Naseby: My Lords, I did not raise figures. I raised—

Lord Warner: My Lords, I wish to continue with my speech.
	Let me respond to some other points that were made about the issues around ventilation. I think that the noble Lord, Lord Clement-Jones, put the points in that area very well. There is a total lack of good evidence that ventilation provides a real solution to the health risks associated with second-hand smoke and we do not want to require expensive and potentially useless ventilation equipment, as that would be burdensome to many of the people involved.
	A lot of concern has been raised about the impact on the home of the ban on smoking in public places and the workplace. The evidence from New York suggests that 100,000 people have quit smoking since the ban was introduced there; in Ireland, cigarette sales in 2004 are 15 per cent down on 2003 and, after the first six months of the ban, an estimated 7,000 more smokers have quit than would otherwise have been expected to. That evidence is also in the public arena for the sceptics to consider as they wish.
	Issues have been raised about exemptions. We shall no doubt go into those in considerable detail in Committee, but I should like to clarify one or two points. The noble Baroness, Lady Masham, raised the issue whether exemptions would extend to prisons. Prisons are exempted due to human rights issues, as prisons are a person's residence. However, I can say to the House—and I shall put this in more detail in writing to noble Lords—that the Prison Service management board has set up a working group with the Department of Health to review all the implications of the smoke-free provisions of the Bill with a view to achieving smoke-free prisons, so that certain safeguards are made for prisoners who do not want to be exposed to the smoke.
	Residential care homes are also to be exempted on human rights grounds, as they are the residences of those living in them, but we shall issue guidance to homes on how best to provide protection from second-hand smoke for other residents and for staff. It is not intended to exempt student halls of residence as such; however, an individual student's private rooms would be exempted, as they are the individual student's residence.
	The noble Baroness, Lady Cumberlege, raised a number of issues around teenage smoking rates. What I can say to her is that the prevalence of smoking among children aged 11 to 15 steadily increased between 1988 and 1996, from 8 per cent to 13 per cent, but that since 1996 the rate has fallen. In 2004, 9 per cent of pupils aged 11 to 15 were regular smokers. We seem to have peaked, and the percentages are coming down.
	The issue of smoking in the Houses of Parliament is a matter for the House authorities, not the Government. It is down to the House whether it wishes to set a good example to other people. My noble friend Lady McIntosh raised the issue of the impact on the theatre industry of the smoke-free provisions. We are still considering representations from the theatre industry; we are aware that in those countries that have already brought in smoke-free legislation there are a number of different approaches to smoking on stage. That will be covered in the public consultation on the regulations to be made under the Bill.
	I turn to some of the issues raised around healthcare-associated infections. I would gently say to the noble Baroness, Lady Cumberlege, and remind the House that MRSA took root in our hospitals between 1993 and 1997. There is good evidence on that and we have put that evidence in the public arena. As a Government, we introduced mandatory surveillance, which has now been extended. I shall give further and better particulars on conditions other than just MRSA. We believe that the code will improve hygiene. The fact that we do not know everything about tackling healthcare-associated infections does not mean that we should not codify what we do know to improve public safety in this area. We know that there is variation across hospitals in the extent to which they have been able to tackle healthcare-associated infections, and we believe that the code will achieve greater uniformity and help to bring up the standards of the less good to the standards of the best. We do not believe that there is any evidence that targets to improve health services have actually had an adverse impact in that area.
	The noble Baroness, Lady Barker, asked why the code did not apply to the independent sector—to residential care and nursing homes. Enhanced standards of infection control should in our view apply in all settings in which healthcare is provided. We will accomplish that through the legal framework of the Care Standards Act 2000, which forms the foundation of the regulation of the private and voluntary healthcare sector and care homes. In other words, the relevant elements of the code will be applied to the independent sector under regulations made under the Care Standards Act.
	The noble Lord, Lord Colwyn, asked whether the healthcare-associated infection code should be delayed until the Bill gains Royal Assent. We obviously want to get this into operation as quickly as possible, but we need to wait until the Bill gains Royal Assent before the new powers given to the Healthcare Commission kick in. But the draft code is already available to all NHS bodies.
	The noble Baroness, Lady Barker, raised some issues around the social care bursary scheme. The transfer is administrative; there is no more significance in it than that. It was a result of the recommendations of the arm's-length body review.
	I turn briefly to a number of issues raised in relation to the Bill's provisions on pharmacy and other areas. I am happy to give the noble Lord, Lord Colwyn, the assurance that the Bill does not affect the work of dispensing doctors. The noble Baronesses, Lady Barker and Lady Murphy, raised concerns about the extent to which people might be put at risk in circumstances in which a pharmacist had responsibilities extending beyond more than one pharmacy. We are trying to ensure that there will be a responsible pharmacist in charge of every pharmacy, even those open 100 hours a week. That pharmacy is expected to be their main place of work. There will be exceptions to the "one responsible pharmacist" rule only in exceptional circumstances. An example already in use in Australia is a pharmacist-controlled vending machine, where the pharmacist safely controls the supply of medicines from another place.
	It would not be sensible to require a responsible pharmacist in that situation to stand by the vending machine on the registered pharmacy premises. The responsible pharmacist will be required to set down procedures and determine which staff are competent to undertake them safely. There are a number of other specifications that would ensure patient safety in this area, and I am happy to put those in writing to noble Lords after this debate.
	I can confirm to the noble Lord, Lord Walton, that we will consult widely on the regulations, and will expect to work closely with pharmacy organisations such as the Royal Pharmaceutical Society of Great Britain, with which we have already been working in preparing this legislation. In those regulations we will clearly define the activities that pharmacists must undertake themselves and those that can be delegated to other competent staff.
	The noble Baroness, Lady Barker, mentioned inspection. It is intended that Royal Pharmaceutical Society inspectors will inspect controlled drugs management in community pharmacies as part of their routine inspections of community pharmacies. That will build on their expertise and minimise disruption.
	I tried to give reassurance in my opening remarks about ophthalmic services. This is not the occasion to go into great detail, but I will try to extend those reassurances in a letter to all noble Lords. The noble Baroness, Lady Masham, raised some concerns about stoma service changes. The consultation on that finished on 23 January. Officials have been meeting with patients' groups to explain the next stages. No decision will be taken until a robust evaluation has been made of the consultation's evidence of the impact of any changes on patients. Like her, we are concerned to ensure that changes do not disadvantage patients in this particular area.
	My noble friend Lord Rosser raised an important set of concerns about support for non-executives and the role they play in the running of NHS bodies. He is quite right to raise those concerns, and I assure him that my right honourable friend Patricia Hewitt and I are pursuing the issue energetically.
	I have tried to cover many of the points noble Lords have raised. I am sure we will go into considerable detail on some of those issues, and I have no doubt that we will be batting around figures about second-hand smoke in a very happy manner, but tonight is not the time to re-enter that fray. I will be pleased to write to noble Lords on all the points I have not managed to cover.

Baroness Murphy: My Lords, before the Minister sits down, in his opening speech he said that the draft code was in the Library. Is the code now signed and sealed, or is it still open to improvement, as the Royal College of Nursing would like?

Lord Warner: My Lords, the code is still in draft form, but we have put the latest version of it in the Library because it is also available in the NHS to help improve standards, even in its non-final form.
	On Question, Bill read a second time.

House adjourned at seventeen minutes before nine o'clock.

Wednesday, 1 March 2006.